Abstract 11695: Risk Factors for Incident Peripheral Arterial Disease in Type 2 Diabetes: Results from the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) Trial

Abstract

Patients with type 2 diabetes mellitus (T2DM) have a high risk of developing peripheral arterial disease (PAD). Known risk factors for PAD include age, race, smoking, and hyperglycemia. We have recently reported that insulin sensitizing treatment is protective for the development of PAD and that insulin use carries a risk of future PAD. We sought to characterize additional risk factors for PAD in a cohort of T2DM patients free of PAD at study entry. We assessed potential risk factors for PAD in 1,479 patients with no history of PAD and a normal ankle-brachial index (0.9<ABI<1.3) at their baseline visit. Patients were classified as an incident PAD case if they experienced any of the following during trial follow-up: new low ABI (<0.9), lower extremity revascularization, or lower extremity amputation. Cox proportional-hazards models were used to characterize the relationships between selected risk factors and incidence of PAD. Over a mean 4.6 years follow-up, 303 (20.5%) patients met at least one of the above criteria for PAD. After adjustment for age, sex, race, smoking status, insulin use at study entry, and treatment assignment, the following factors were significantly associated with incident PAD risk: high albumin-creatinine ratio (HR=1.77, 95% CI: 1.20-2.59), diabetic peripheral neuropathy (HR=1.51, 95% CI: 1.18-1.93), and pulse pressure (highest quartile vs. lowest quartile HR=1.81, 95% CI: 1.24-2.66). Adjusting for glycated hemoglobin (HbA1c) does not attenuate these effects, suggesting that these effects are independent of hyperglycemia. We found no evidence of an association with glycemic control (baseline or in-trial HbA1c), duration of diabetes, hypertension, lipids, inflammatory markers, or hemostatic markers. In conclusion, our analysis identified several independent risk factors for PAD beyond traditional CVD and T2DM risk factors. These markers might be useful to identify T2DM patients with especially high risk of developing PAD.