Microvascular and macrovascular disease and risk for major peripheral arterial disease in patients with type 2 diabetes

Kamel Mohammedi, Mark Woodward, Yoichiro Hirakawa, Sophia Zoungas, Bryan Williams, Liu Lisheng, Anthony Rodgers, Giuseppe Mancia, Bruce Neal, Stephen Harrap, Michel Marre, John Chalmers

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

OBJECTIVE Peripheral arterial disease (PAD) is a common manifestation of atherosclerosis in type 2 diabetes, but the relationship between other vascular diseases and PAD has been poorly investigated. We examined the impact of previousmicrovascular and macrovascular disease on the risk of major PAD in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS We analyzed 10,624 patients with type 2 diabetes free frombaselinemajor PAD in the Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation (ADVANCE) clinical trial. The primary composite outcome was major PAD defined as PAD-induced death, peripheral revascularization, lowerlimb amputation, or chronic ulceration. The secondary end points were the PAD components considered separately. RESULTS Major PAD occurred in 620 (5.8%) participants during 5 years of follow-up. Baseline microvascular and macrovascular disease were both associated with subsequent risk of major PAD after adjustment for age, sex, region of origin, and randomized treatments. However, only microvascular disease remained significantly associated with PAD after further adjustment for established risk factors. The highest risk was observed in participants with a history of macroalbuminuria (hazard ratio 1.91 [95% CI 1.38-2.64], P < 0.0001) and retinal photocoagulation therapy (1.60 [1.11-2.32], P = 0.01). Baseline microvascular disease was also associated with a higher risk of chronic lower-limb ulceration (2.07 [1.56-2.75], P < 0.0001) and amputation (1.59 [1.15-2.22], P = 0.006),whereas baselinemacrovascular disease was associatedwith a higher rate of angioplasty procedures (1.75 [1.13-2.73], P = 0.01). CONCLUSIONS Microvascular disease, particularly macroalbuminuria and retinal photocoagulation therapy, strongly predicts major PAD in patients with type 2 diabetes, but macrovascular disease does not.

Original languageEnglish
Pages (from-to)1796-1803
Number of pages8
JournalDiabetes care
Volume39
Issue number10
DOIs
Publication statusPublished - Oct 1 2016
Externally publishedYes

Fingerprint

Peripheral Arterial Disease
Type 2 Diabetes Mellitus
perindopril drug combination indapamide
Light Coagulation
Vascular Diseases
Amputation
Gliclazide
Angioplasty
Lower Extremity
Atherosclerosis
Therapeutics
Clinical Trials

All Science Journal Classification (ASJC) codes

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialised Nursing

Cite this

Microvascular and macrovascular disease and risk for major peripheral arterial disease in patients with type 2 diabetes. / Mohammedi, Kamel; Woodward, Mark; Hirakawa, Yoichiro; Zoungas, Sophia; Williams, Bryan; Lisheng, Liu; Rodgers, Anthony; Mancia, Giuseppe; Neal, Bruce; Harrap, Stephen; Marre, Michel; Chalmers, John.

In: Diabetes care, Vol. 39, No. 10, 01.10.2016, p. 1796-1803.

Research output: Contribution to journalArticle

Mohammedi, K, Woodward, M, Hirakawa, Y, Zoungas, S, Williams, B, Lisheng, L, Rodgers, A, Mancia, G, Neal, B, Harrap, S, Marre, M & Chalmers, J 2016, 'Microvascular and macrovascular disease and risk for major peripheral arterial disease in patients with type 2 diabetes', Diabetes care, vol. 39, no. 10, pp. 1796-1803. https://doi.org/10.2337/dc16-0588
Mohammedi, Kamel ; Woodward, Mark ; Hirakawa, Yoichiro ; Zoungas, Sophia ; Williams, Bryan ; Lisheng, Liu ; Rodgers, Anthony ; Mancia, Giuseppe ; Neal, Bruce ; Harrap, Stephen ; Marre, Michel ; Chalmers, John. / Microvascular and macrovascular disease and risk for major peripheral arterial disease in patients with type 2 diabetes. In: Diabetes care. 2016 ; Vol. 39, No. 10. pp. 1796-1803.
@article{e1339098dbd347a2be018858d3145a7f,
title = "Microvascular and macrovascular disease and risk for major peripheral arterial disease in patients with type 2 diabetes",
abstract = "OBJECTIVE Peripheral arterial disease (PAD) is a common manifestation of atherosclerosis in type 2 diabetes, but the relationship between other vascular diseases and PAD has been poorly investigated. We examined the impact of previousmicrovascular and macrovascular disease on the risk of major PAD in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS We analyzed 10,624 patients with type 2 diabetes free frombaselinemajor PAD in the Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation (ADVANCE) clinical trial. The primary composite outcome was major PAD defined as PAD-induced death, peripheral revascularization, lowerlimb amputation, or chronic ulceration. The secondary end points were the PAD components considered separately. RESULTS Major PAD occurred in 620 (5.8{\%}) participants during 5 years of follow-up. Baseline microvascular and macrovascular disease were both associated with subsequent risk of major PAD after adjustment for age, sex, region of origin, and randomized treatments. However, only microvascular disease remained significantly associated with PAD after further adjustment for established risk factors. The highest risk was observed in participants with a history of macroalbuminuria (hazard ratio 1.91 [95{\%} CI 1.38-2.64], P < 0.0001) and retinal photocoagulation therapy (1.60 [1.11-2.32], P = 0.01). Baseline microvascular disease was also associated with a higher risk of chronic lower-limb ulceration (2.07 [1.56-2.75], P < 0.0001) and amputation (1.59 [1.15-2.22], P = 0.006),whereas baselinemacrovascular disease was associatedwith a higher rate of angioplasty procedures (1.75 [1.13-2.73], P = 0.01). CONCLUSIONS Microvascular disease, particularly macroalbuminuria and retinal photocoagulation therapy, strongly predicts major PAD in patients with type 2 diabetes, but macrovascular disease does not.",
author = "Kamel Mohammedi and Mark Woodward and Yoichiro Hirakawa and Sophia Zoungas and Bryan Williams and Liu Lisheng and Anthony Rodgers and Giuseppe Mancia and Bruce Neal and Stephen Harrap and Michel Marre and John Chalmers",
year = "2016",
month = "10",
day = "1",
doi = "10.2337/dc16-0588",
language = "English",
volume = "39",
pages = "1796--1803",
journal = "Diabetes Care",
issn = "1935-5548",
publisher = "American Diabetes Association Inc.",
number = "10",

}

TY - JOUR

T1 - Microvascular and macrovascular disease and risk for major peripheral arterial disease in patients with type 2 diabetes

AU - Mohammedi, Kamel

AU - Woodward, Mark

AU - Hirakawa, Yoichiro

AU - Zoungas, Sophia

AU - Williams, Bryan

AU - Lisheng, Liu

AU - Rodgers, Anthony

AU - Mancia, Giuseppe

AU - Neal, Bruce

AU - Harrap, Stephen

AU - Marre, Michel

AU - Chalmers, John

PY - 2016/10/1

Y1 - 2016/10/1

N2 - OBJECTIVE Peripheral arterial disease (PAD) is a common manifestation of atherosclerosis in type 2 diabetes, but the relationship between other vascular diseases and PAD has been poorly investigated. We examined the impact of previousmicrovascular and macrovascular disease on the risk of major PAD in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS We analyzed 10,624 patients with type 2 diabetes free frombaselinemajor PAD in the Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation (ADVANCE) clinical trial. The primary composite outcome was major PAD defined as PAD-induced death, peripheral revascularization, lowerlimb amputation, or chronic ulceration. The secondary end points were the PAD components considered separately. RESULTS Major PAD occurred in 620 (5.8%) participants during 5 years of follow-up. Baseline microvascular and macrovascular disease were both associated with subsequent risk of major PAD after adjustment for age, sex, region of origin, and randomized treatments. However, only microvascular disease remained significantly associated with PAD after further adjustment for established risk factors. The highest risk was observed in participants with a history of macroalbuminuria (hazard ratio 1.91 [95% CI 1.38-2.64], P < 0.0001) and retinal photocoagulation therapy (1.60 [1.11-2.32], P = 0.01). Baseline microvascular disease was also associated with a higher risk of chronic lower-limb ulceration (2.07 [1.56-2.75], P < 0.0001) and amputation (1.59 [1.15-2.22], P = 0.006),whereas baselinemacrovascular disease was associatedwith a higher rate of angioplasty procedures (1.75 [1.13-2.73], P = 0.01). CONCLUSIONS Microvascular disease, particularly macroalbuminuria and retinal photocoagulation therapy, strongly predicts major PAD in patients with type 2 diabetes, but macrovascular disease does not.

AB - OBJECTIVE Peripheral arterial disease (PAD) is a common manifestation of atherosclerosis in type 2 diabetes, but the relationship between other vascular diseases and PAD has been poorly investigated. We examined the impact of previousmicrovascular and macrovascular disease on the risk of major PAD in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS We analyzed 10,624 patients with type 2 diabetes free frombaselinemajor PAD in the Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation (ADVANCE) clinical trial. The primary composite outcome was major PAD defined as PAD-induced death, peripheral revascularization, lowerlimb amputation, or chronic ulceration. The secondary end points were the PAD components considered separately. RESULTS Major PAD occurred in 620 (5.8%) participants during 5 years of follow-up. Baseline microvascular and macrovascular disease were both associated with subsequent risk of major PAD after adjustment for age, sex, region of origin, and randomized treatments. However, only microvascular disease remained significantly associated with PAD after further adjustment for established risk factors. The highest risk was observed in participants with a history of macroalbuminuria (hazard ratio 1.91 [95% CI 1.38-2.64], P < 0.0001) and retinal photocoagulation therapy (1.60 [1.11-2.32], P = 0.01). Baseline microvascular disease was also associated with a higher risk of chronic lower-limb ulceration (2.07 [1.56-2.75], P < 0.0001) and amputation (1.59 [1.15-2.22], P = 0.006),whereas baselinemacrovascular disease was associatedwith a higher rate of angioplasty procedures (1.75 [1.13-2.73], P = 0.01). CONCLUSIONS Microvascular disease, particularly macroalbuminuria and retinal photocoagulation therapy, strongly predicts major PAD in patients with type 2 diabetes, but macrovascular disease does not.

UR - http://www.scopus.com/inward/record.url?scp=84988954344&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84988954344&partnerID=8YFLogxK

U2 - 10.2337/dc16-0588

DO - 10.2337/dc16-0588

M3 - Article

VL - 39

SP - 1796

EP - 1803

JO - Diabetes Care

JF - Diabetes Care

SN - 1935-5548

IS - 10

ER -