Abstract
BackgroundIndividuals with peripheral artery disease (PAD) often have reduced physical activity, which may increase the future risk of diabetes mellitus. Although diabetes is a risk factor for PAD, whether low ankle-brachial index (ABI) predates diabetes has not been studied.MethodsWe examined the association of ABI with incident diabetes using Cox proportional hazards models in the ARIC Study. ABI was measured in 12,247 black and white participants without prevalent diabetes at baseline (1987–1989). Incident diabetes cases were identified by blood glucose levels at three subsequent visits (1990–92, 1993–95, and 1996–98) or self-reported physician diagnosis or medication use at those visits or during annual phone interview afterward through 2011.ResultsA total of 3305 participants developed diabetes during a median of 21 years of follow-up. Participants with low (≤0.90) and borderline low (0.91–1.00) ABI had 30–40% higher risk of future diabetes as compared to those with ABI of 1.10–1.20 in the demographically adjusted model. The associations were attenuated after further adjustment for other potential confounders but remained significant for ABI 0.91–1.00 (HR = 1.17, 95% CI 1.04–1.31) and marginally significant for ABI ≤ 0.90 (HR = 1.19, 0.99–1.43). Although the association was largely consistent across subgroups, a stronger association was seen in participants without hypertension, those with normal fasting glucose, and those with a history of stroke compared to their counterparts.ConclusionsLow ABI was modestly but independently associated with increased risk of incident diabetes in the general population. Clinical attention should be paid to the glucose trajectory among people with low ABI but without diabetes.Electronic supplementary materialThe online version of this article (doi:10.1186/s12933-016-0476-4) contains supplementary material, which is available to authorized users.
Highlights
Individuals with peripheral artery disease (PAD) often have reduced physical activity, which may increase the future risk of diabetes mellitus
We aimed to investigate whether ankle-brachial index (ABI) is independently associated with incident diabetes in a community-based cohort, the Atherosclerosis Risk in Communities (ARIC) Study
There was no significant correlation between ABI and baseline fasting glucose (r = 0.002, p value = 0.81)
Summary
Individuals with peripheral artery disease (PAD) often have reduced physical activity, which may increase the future risk of diabetes mellitus. Diabetes is a risk factor for PAD, whether low ankle-brachial index (ABI) predates diabetes has not been studied. Lower extremity peripheral arterial disease (PAD), typically defined by an ankle-brachial index (ABI) < 0.9 [1], affects 8–10 million people in the United States [2]. Regardless of leg symptoms, patients with PAD experience functional decline and impairment [5,6,7], which are shown to result in reduced level of physical activity [8, 9]. Since physically inactivity is an important risk factor of diabetes mellitus [10], it is possible that low ABI is associated with the development of diabetes. We aimed to investigate whether ABI is independently associated with incident diabetes in a community-based cohort, the Atherosclerosis Risk in Communities (ARIC) Study
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