Chronic leg ulcer is a strong predictor to determine the major cardiovascular events in diabetic patients with peripheral arterial disease in Thailand

Abstract

Peripheral arterial disease (PAD) in patients with diabetic mellitus (DM) is a fatal condition. The most common causes of morbidity and mortality in these patients are major adverse cardiovascular events (MACE) such as myocardial infarction and death. Therefore, the study on prognostic factors of MACE in these patients is important. A multi-center, prospective cohort study of 500 DM patients with PAD, between June 2014 and July 2016, were followed up in 18 months. Primary end point was MACE, which included non-fatal myocardial infarction, stroke, worsening PAD, and death. The prognostic factors, which aggregated from recent literatures, were entered into a Cox proportional hazard model. The adequacies of treatments were evaluated by assessing the risk factor control for atherosclerosis. This project was supported by the Health System Research Institute (HSRI) Thailand. Ninety-five MACE occurred. The prognostic factors associated with MACE were chronic kidney disease (CKD) (HR 2.32, 95% CI 1.41–3.80), gangrene/chronic ulcer (HR 3.03, 95% CI 1.82–5.06), history of aortic surgery (HR 24.07, 95% CI 5.28–109.71), history of taking clopidogrel (HR 2.16, 95% CI 1.13–4.12), and history of taking warfarin (HR 3.24, 95% CI 1.50–7.02). In atherosclerosis risk factor management, patients had reached the target in the control of diastolic blood pressure (73.10%) and stopped smoking (91.83%). In summary, the prognostic factors for MACE in Thai DM patients with PAD were CKD, gangrene/chronic ulcer, history of aortic surgery, and patients with history of taking clopidogrel or warfarin. The optimization of prognostic factors and atherosclerosis risk factor should be campaigned to reduce the morbidity and mortality of these patients.