Clinical study
Effect of type 2 diabetes and its duration on the risk of peripheral arterial disease among men

https://doi.org/10.1016/j.amjmed.2003.09.038Get rights and content

Abstract

Purpose

To assess the relation between the duration of diabetes and the risk of peripheral arterial disease among men.

Methods

A total of 48,607 men in the Health Professionals Follow-up Study who returned a questionnaire in 1986 were followed for 12 years. Peripheral arterial disease (intermittent claudication or surgery for peripheral arterial diseases in the lower extremities) was ascertained by biennial questionnaire and confirmed by medical record review. Diabetes status and other cardiovascular risk factors were also ascertained by biennial questionnaire.

Results

During follow-up (534,588 person-years), we documented 387 cases of peripheral arterial disease. After adjusting for cardiovascular risk factors, the relative risk of developing peripheral arterial disease among men with diabetes compared with men without diabetes was 2.61 (95% confidence interval [CI]: 1.98 to 3.45). Compared with men without diabetes, the relative risk of peripheral arterial disease among men with diabetes increased with duration of disease, even after adjusting for cardiovascular risk factors: 1.39 (95% CI: 0.82 to 2.36) for 1 to 5 years of diabetes, 3.63 (95% CI: 2.23 to 5.88) for 6 to 10 years, 2.55 (95% CI: 1.50 to 4.32) for 11 to 25 years, and 4.53 (95% CI: 2.39 to 8.58) for >25 years of diabetes (P for trend ≤0.0001).

Conclusion

These results indicate that duration of type 2 diabetes is associated strongly with the risk of developing peripheral arterial disease.

Section snippets

Methods

The Health Professionals Follow-up Study is a prospective cohort initiated in 1986, when 51,529 predominantly white men aged 40 to 75 years answered a detailed questionnaire by mail on diet and medical history (12). The cohort consisted of dentists (57.6%), veterinarians (19.6%), pharmacists (8.1%), optometrists (7.3%), osteopathic physicians (4.3%), and podiatrists (3.1%). All states of the United States were represented, and no exclusions were made by race. Every 2 years, follow-up

Results

During 534,588 person-years over 12 years of follow-up (1986 to 1998), we documented 387 cases of peripheral arterial disease among 48,607 men. At the beginning of the study, there were 2218 diabetic patients; 1895 new cases were diagnosed during follow-up. Men who developed peripheral arterial disease were older, consumed more alcohol, smoked more cigarettes, took more aspirin, were physically less active, and more likely to have a history of hypertension and high cholesterol (Table 1).

The

Discussion

In this prospective cohort study, we found a strong posi-tive association between the duration of diabetes and the risk of developing peripheral arterial disease. The association between diabetes status and peripheral arterial disease was particularly strong among men with hypertension or who were current smokers, and these two variables were also important independent risk factors for peripheral arterial disease.

An advantage of this study was the relatively long follow-up (12 years) and the

Acknowledgements

The authors would like to acknowledge the contribution of Tricia Li and Ellen Hertzmark to this manuscript.

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    This study was supported by research grants HL35464 and CA55075 from the National Institutes of Health, Bethesda, Maryland, and a research grant from the American Diabetes Association.

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