Presentations of major peripheral arterial disease and risk of major outcomes in patients with type 2 diabetes: results from the ADVANCE-ON study
Background: Peripheral arterial disease (PAD) is known to be associated with high cardiovascular risk, but the individual impact of PAD presentations on risk of macrovascular and microvascular events has not been reliably compared in patients with type 2 diabetes. We aimed to evaluate the impact of...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Journal article |
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BioMed Central
2016
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| _version_ | 1826305641326575616 |
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| author | Mohammedi, K Woodward, M Hirakawa, Y Zoungas, S Colagiuri, S Hamet, P Harrap, S Poulter, N Matthews, D Marre, M Chalmers, J ADVANCE Collaborative Group |
| author_facet | Mohammedi, K Woodward, M Hirakawa, Y Zoungas, S Colagiuri, S Hamet, P Harrap, S Poulter, N Matthews, D Marre, M Chalmers, J ADVANCE Collaborative Group |
| author_sort | Mohammedi, K |
| collection | OXFORD |
| description | Background: Peripheral arterial disease (PAD) is known to be associated with high cardiovascular risk, but the individual impact of PAD presentations on risk of macrovascular and microvascular events has not been reliably compared in patients with type 2 diabetes. We aimed to evaluate the impact of major PAD, and its different presentations, on the 10-year risk of death, major macrovascular events, and major clinical microvascular events in these patients.<br/> Methods: Participants in the Action in Diabetes and Vascular Disease: PreterAx and DiamicroN Modified-Release Controlled Evaluation (ADVANCE) trial and the ADVANCE-ON post-trial study were followed for a median of 5.0 (in-trial), 5.4 (post-trial), and 9.9 (overall) years. Major PAD at baseline was subdivided into lower-extremity chronic ulceration or amputation secondary to vascular disease and history of peripheral revascularisation by angioplasty or surgery.<br/> Results: Among 11140 participants, 516 (4.6%) had major PAD at baseline: 300 (2.7%) had lower-extremity ulceration or amputation alone, 190 (1.7%) had peripheral revascularisation alone, and 26 (0.2%) had both presentations. All-cause mortality, major macrovascular events, and major clinical microvascular events occurred in 2265 (20.3%), 2166 (19.4%), and 807 (7.2%) participants, respectively. Compared to those without PAD, patients with major PAD had increased rates of all-cause mortality (HR 1.35, 95%CI 1.15-1.60, p=0.0004), and major macrovascular events (1.47 [1.23-1.75], p<0.0001), after multiple adjustments for region of origin, cardiovascular risk factors and treatments, peripheral neuropathy markers, and randomized treatments. We have also observed a trend toward an association of baseline PAD with risk of major clinical microvascular events (1.31 [0.96-1.78], p=0.09). These associations were comparable for patients with a lower-extremity ulceration or amputation and for those with a history of peripheral revascularisation. Furthermore, the risk of retinal photocoagulation or blindness, but not renal events, increased in patients with lower-extremity ulceration or amputation (1.53 [1.01-2.30], p=0.04).<br/> Conclusions: Lower-extremity ulceration or amputation, and peripheral revascularisation both increased the risks of death and cardiovascular events, but only lower-extremity ulceration or amputation increased the risk of severe retinopathy in patients with type 2 diabetes. Screening for major PAD and its management remain crucial for cardiovascular prevention in patients with type 2 diabetes (ClinicalTrials.gov number, NCT00949286). |
| first_indexed | 2024-03-07T06:35:55Z |
| format | Journal article |
| id | oxford-uuid:f79ef499-c209-4a5d-9290-d637b0278766 |
| institution | University of Oxford |
| last_indexed | 2024-03-07T06:35:55Z |
| publishDate | 2016 |
| publisher | BioMed Central |
| record_format | dspace |
| spelling | oxford-uuid:f79ef499-c209-4a5d-9290-d637b02787662022-03-27T12:44:08ZPresentations of major peripheral arterial disease and risk of major outcomes in patients with type 2 diabetes: results from the ADVANCE-ON studyJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:f79ef499-c209-4a5d-9290-d637b0278766Symplectic Elements at OxfordBioMed Central2016Mohammedi, KWoodward, MHirakawa, YZoungas, SColagiuri, SHamet, PHarrap, SPoulter, NMatthews, DMarre, MChalmers, JADVANCE Collaborative GroupBackground: Peripheral arterial disease (PAD) is known to be associated with high cardiovascular risk, but the individual impact of PAD presentations on risk of macrovascular and microvascular events has not been reliably compared in patients with type 2 diabetes. We aimed to evaluate the impact of major PAD, and its different presentations, on the 10-year risk of death, major macrovascular events, and major clinical microvascular events in these patients.<br/> Methods: Participants in the Action in Diabetes and Vascular Disease: PreterAx and DiamicroN Modified-Release Controlled Evaluation (ADVANCE) trial and the ADVANCE-ON post-trial study were followed for a median of 5.0 (in-trial), 5.4 (post-trial), and 9.9 (overall) years. Major PAD at baseline was subdivided into lower-extremity chronic ulceration or amputation secondary to vascular disease and history of peripheral revascularisation by angioplasty or surgery.<br/> Results: Among 11140 participants, 516 (4.6%) had major PAD at baseline: 300 (2.7%) had lower-extremity ulceration or amputation alone, 190 (1.7%) had peripheral revascularisation alone, and 26 (0.2%) had both presentations. All-cause mortality, major macrovascular events, and major clinical microvascular events occurred in 2265 (20.3%), 2166 (19.4%), and 807 (7.2%) participants, respectively. Compared to those without PAD, patients with major PAD had increased rates of all-cause mortality (HR 1.35, 95%CI 1.15-1.60, p=0.0004), and major macrovascular events (1.47 [1.23-1.75], p<0.0001), after multiple adjustments for region of origin, cardiovascular risk factors and treatments, peripheral neuropathy markers, and randomized treatments. We have also observed a trend toward an association of baseline PAD with risk of major clinical microvascular events (1.31 [0.96-1.78], p=0.09). These associations were comparable for patients with a lower-extremity ulceration or amputation and for those with a history of peripheral revascularisation. Furthermore, the risk of retinal photocoagulation or blindness, but not renal events, increased in patients with lower-extremity ulceration or amputation (1.53 [1.01-2.30], p=0.04).<br/> Conclusions: Lower-extremity ulceration or amputation, and peripheral revascularisation both increased the risks of death and cardiovascular events, but only lower-extremity ulceration or amputation increased the risk of severe retinopathy in patients with type 2 diabetes. Screening for major PAD and its management remain crucial for cardiovascular prevention in patients with type 2 diabetes (ClinicalTrials.gov number, NCT00949286). |
| spellingShingle | Mohammedi, K Woodward, M Hirakawa, Y Zoungas, S Colagiuri, S Hamet, P Harrap, S Poulter, N Matthews, D Marre, M Chalmers, J ADVANCE Collaborative Group Presentations of major peripheral arterial disease and risk of major outcomes in patients with type 2 diabetes: results from the ADVANCE-ON study |
| title | Presentations of major peripheral arterial disease and risk of major outcomes in patients with type 2 diabetes: results from the ADVANCE-ON study |
| title_full | Presentations of major peripheral arterial disease and risk of major outcomes in patients with type 2 diabetes: results from the ADVANCE-ON study |
| title_fullStr | Presentations of major peripheral arterial disease and risk of major outcomes in patients with type 2 diabetes: results from the ADVANCE-ON study |
| title_full_unstemmed | Presentations of major peripheral arterial disease and risk of major outcomes in patients with type 2 diabetes: results from the ADVANCE-ON study |
| title_short | Presentations of major peripheral arterial disease and risk of major outcomes in patients with type 2 diabetes: results from the ADVANCE-ON study |
| title_sort | presentations of major peripheral arterial disease and risk of major outcomes in patients with type 2 diabetes results from the advance on study |
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