The aim of this study was to compare the prognosis of patients according to diabetes status, during a 1-year follow-up after hospital admission for lower extremity artery disease, in the prospective COPART (COhorte de Patients ARTériopathes) registry. Inclusion criteria were intermittent claudication, ischemic rest pain, tissue loss, or acute limb ischemia, with radiological and hemodynamic confirmation. Among 2494 patients, 1235 (49.5%) had diabetes. Incidence rates for major adverse cardiovascular events (MACE) were 18.0/100 person-years (95% confidence interval [CI], 15.4–21.0) for the diabetes group and 11.1/100 person-years (95% CI, 9.2–13.4) for the non-diabetes group. Incidence rates of all-cause mortality were 29.8/100 person-years (95% CI, 26.5–33.4) for the diabetes group and 19.7/100 person-years (95% CI, 17.2–22.7) for the non-diabetes group. Incidence rates of major limb amputation were 24.2/100 person-years (95% CI, 21.1–27.8) for the diabetes group and 11.6/100 person-years (95% CI, 9.6–14.0) for the non-diabetes group. Diabetes was associated with MACE, adjusted hazard ratio 1.60 (95% CI, 1.16–2.22), and all-cause mortality, unadjusted HR 1.49 (95% CI, 1.24–1.78). In the multivariate analysis, diabetes was no longer associated with major amputation, adjusted HR 1.15 (95% CI, .87–1.51). Patients hospitalized for LEAD with diabetes had a higher risk of MACE than those without diabetes.
AnandSDagenaisGMohanV, et al.Glucose levels are associated with cardiovascular disease and death in an international cohort of normal glycaemic and dysglycaemic men and women: the epidream cohort study. Eur J Prev. Cardiol2012; 19: 755–764.
2.
RawshaniARawshaniAFranzénS, et al.Mortality and cardiovascular disease in type 1 and type 2 diabetes. N Engl J Med2017; 376: 1407–1418.
3.
TancrediMRosengrenASvenssonA-M, et al.Excess mortality among persons with type 2 diabetes. N Engl J Med2015; 373: 1720–1732.
4.
FowkesFGRRudanDRudanI, et al.Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis. Lancet2013; 382: 1329–1340.
5.
AlthouseADAbbottJDForkerAD, et al.Risk factors for incident peripheral arterial disease in type 2 diabetes: results from the bypass angioplasty revascularization investigation in type 2 diabetes (bari 2d) trial. Diabetes Care2014; 37: 1346–1352.
6.
MohammediKWoodwardMHirakawaY, et al. Microvascular and macrovascular disease and risk for major peripheral arterial disease in patients with type 2 diabetes. Diabetes Care2016; 39: 1796–1803.
7.
MalyarNMFreisingerEMeyborgM, et al.Amputations and mortality in in-hospital treated patients with peripheral artery disease and diabetic foot syndrome. J Diabetes Complicat2016; 30: 1117–1122.
8.
VrsalovicMVucurKVrsalovic PreseckiAFabijanicDMilosevicM. Impact of diabetes on mortality in peripheral artery disease: a meta-analysis. Clin Cardiol2017; 40: 287–291.
9.
HumphriesMDBrunsonAHedayatiNRomanoPMelnkowJ. amputation risk in patients with diabetes mellitus and peripheral artery disease using statewide data. Ann Vasc Surg2016; 30: 123–131.
10.
AgnelliGBelchJJFBaumgartnerIGiovasPHoffmannU. Morbidity and mortality associated with atherosclerotic peripheral artery disease: a systematic review. Atherosclerosis2020; 293: 94–100.
11.
AboyansVRiccoJBBartelinkMEL, et al.2017 ESC guidelines on the diagnosis and treatment of peripheral arterial diseases, in collaboration with the european society for vascular surgery (ESVS): document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries endorsed by: the European stroke organization (ESO)the task force for the diagnosis and treatment of peripheral arterial diseases of the european society of cardiology (ESC) and of the European society for vascular surgery (ESVS). Eur Heart J2017; 39: 763–816.
12.
Low WangCCBlomsterJIHeizerG, et al.Cardiovascular and limb outcomes in patients with diabetes and peripheral artery disease. J Am Coll Cardiol2018; 72: 3274–3284.
13.
CambouJPAboyansVConstansJLacroixPDentansCBuraA. Characteristics and outcome of patients hospitalised for lower extremity peripheral artery disease in France: the COPART Registry. Eur J Vasc Endovasc Surg2010; 39: 577–585.
14.
Gerhard-HermanMDGornikHLBarrettC, et al.AHA/ACC guideline on the management of patients with lower extremity peripheral artery disease: executive summary: a report of the American college of cardiology/american heart association task force on clinical practice guidelines. Circulation2016; 135: e686.
15.
FrankUNikolSBelchJ, et al.ESVM guideline on peripheral arterial disease. VASA. zeitschrift fur gefasskrankheiten2019; 48(Suppl 102): 1–79.
16.
ConteMSConteMSPomposelliFB, et al.Society for Vascular Surgery Lower Extremity Guidelines Writing Group. Society for vascular surgery practice guidelines for atherosclerotic occlusive disease of the lower extremities: management of asymptomatic disease and claudication. J Vasc Surg2015; 61(3 Suppl l): 2S–41S.
17.
LapébieF-XBura-RivièreALacroixP, et al.Impact of angiotensin receptor blockers on mortality after hospitalization for symptomatic lower extremity artery disease. Eur Heart J Cardiovasc Pharmacother2020 Apr 9: pvaa026. Doi: 10.1093/ehjcvp/pvaa026.
18.
CoudeneALapébieF-XDesormaisI, et al.evolution of major amputation risk in patients hospitalized in france for critical limb ischemia: the COPART registry. Angiology2021; 72: 315–321.
19.
AlbertiKGMMEckelRHGrundySM, et al.Harmonizing the metabolic syndrome: a joint interim statement of the international diabetes federation task force on epidemiology and prevention; national heart, lung, and blood institute; American heart association; world heart federation; international atherosclerosis society; and international association for the study of obesity. Circulation2009; 120: 1640–1645.
20.
ConteMSBradburyAWKolhP, et al. Global vascular guidelines on the management of chronic limb-threatening ischemia. J Vasc Surg2019; 69(6S): 3S–e40.
21.
LeveyASStevensLASchmidCH, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med2009; 150: 604–612.
22.
LeveyASEckardtK-UDormanNM, et al. Nomenclature for kidney function and disease: executive summary and glossary from a kidney disease: improving global outcomes consensus conference. Transplantation2020; 104: 1986–1994.
23.
CaroJMigliaccio-WalleKIshakKJProskorovskyI. The morbidity and mortality following a diagnosis of peripheral arterial disease: long-term follow-up of a large database. BMC Cardiovasc Disord2005; 5: 14.
24.
MuellerTHinterreiterFLuftCPoelzWHaltmayerMDieplingerB. Mortality rates and mortality predictors in patients with symptomatic peripheral artery disease stratified according to age and diabetes. J Vasc Surg2014; 59: 1291–1299.
25.
Abu DabrhAMSteffenMWUndavalliC, et al.The natural history of untreated severe or critical limb ischemia. J Vasc Surg2015; 62: 1642–1651.
26.
ReineckeHUnrathMFreisingerE, et al.Peripheral arterial disease and critical limb ischaemia: still poor outcomes and lack of guideline adherence. Eur Heart J2015; 36: 932–938.
27.
BeckmanJACreagerMALibbyP. Diabetes and atherosclerosis. J Am Med Assoc2002; 287: 2570–2581.
28.
GolledgeJQuigleyFVeluRWalkerPJMoxonJV. Association of impaired fasting glucose, diabetes and their management with the presentation and outcome of peripheral artery disease: a cohort study. Cardiovasc Diabetol2014; 13: 147.
29.
AnandSSCaronFEikelboomJW, et al. Major adverse limb events and mortality in patients with peripheral artery disease: the COMPASS trial. J Am Coll Cardiol2018; 71: 2306–2315.
30.
SigvantBHasvoldPKragstermanB, et al.Cardivascular outcomes in patients with peripheral arterial disease as an initial or subsequent manifestation of atherosclerotic disease: results from a Swedish nationwide study. J Vasc Surg2017; 66: 507–514.
31.
Kennedy-MartinTCurtisSFariesDRobinsonSJohnstonJ. A literature review on the representativeness of randomized controlled trial samples and implications for the external validity of trial results. Trials2015; 16: 495.
32.
ParaskevasKIde BorstGJVeithFJ. Why randomized controlled trials do not always reflect reality. J Vasc Surg2019; 70: 607–614.
33.
SigvantBLundinFWahlbergE. The risk of disease progression in peripheral arterial disease is higher than expected: a meta-analysis of mortality and disease progression in peripheral arterial disease. Eur J Vasc Endovasc Surg2016; 51: 395–403.
34.
SartipyFSigvantBLundinFWahlbergE. Ten year mortality in different peripheral arterial disease stages: a population based observational study on outcome. Eur J Vasc Endovasc Surg2018; 55: 529–536.
35.
VisonàADe PaoliAFedeliU, et al.Abnormal ankle-brachial index (ABI) predicts primary and secondary cardiovascular risk and cancer mortality. Eur J Intern Med2020; 77: 79–85.
36.
FiottiNAltamuraNCappelliCSchillanMGuarnieriGGiansanteC. Long term prognosis in patients with peripheral arterial disease treated with antiplatelet agents. Eur J Vasc Endovasc Surg2003; 26: 374–380.
37.
RantnerBKolleritsBPohlhammerJ, et al.The fate of patients with intermittent claudication in the 21st century revisited - results from the CAVASIC Study. Sci Rep2017; 7: 45833.
38.
KoeneRJPrizmentAEBlaesAKonetySH. Shared risk factors in cardiovascular disease and cancer. Circulation2016; 133: 1104–1114.
39.
RaghavanSVassyJLHoYL, et al.Diabetes mellitus-related all-cause and cardiovascular mortality in a national cohort of adults. J Am Heart Assoc2019; 8: e011295.
40.
AboyansVCriquiMHDenenbergJOKnokeJDRidkerPMFronekA. Risk factors for progression of peripheral arterial disease in large and small vessels. Circulation2006; 113: 2623–2629.
41.
FerraresiRMauriGLosurdoF, et al.BAD transmission and SAD distribution: a new scenario for critical limb ischemia. J Cardiovasc Surg2018; 59: 655–664.
42.
AhmadJ. The diabetic foot. Diabetes & Metabolic Syndrome: Clin Res Rev2016; 10: 48–60.
43.
SpreenMIGremmelsHTeraaM, et al.Diabetes is associated with decreased limb survival in patients with critical limb ischemia: pooled data from two randomized controlled trials. Diabetes Care2016; 39: 2058–2064.
44.
LeeH-FChenS-WLiuJ-R, et al.Major adverse cardiovascular and limb events in patients with diabetes and concomitant peripheral artery disease treated with sodium glucose cotransporter 2 inhibitor versus dipeptidyl peptidase-4 inhibitor. Cardiovasc Diabetol2020; 19: 160.
45.
BonacaMPBauersachsRMAnandSS, et al.Rivaroxaban in peripheral artery disease after revascularization. N Engl J Med2020; 382: 1994–2004.
46.
KaplovitchEEikelboomJWDyalL, et al.Rivaroxaban and aspirin in patients with symptomatic lower extremity peripheral artery disease: a subanalysis of the COMPASS randomized clinical trial. JAMA cardiology2021; 6: 21–29.
47.
PaulSKBhattDLMontvidaO. The association of amputations and peripheral artery disease in patients with type 2 diabetes mellitus receiving sodium-glucose cotransporter type-2 inhibitors: real-world study. Eur Heart J2021; 42: 1728–1738.
48.
PatouliasDPapadopoulosCDoumasM. Updated meta-analysis assessing the risk of amputation with sodium-glucose co-transporter-2 inhibitors in the hallmark cardiovascular and renal outcome trials. Diabetes Obes Metabol2021; 23: 1063–1065.
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