Epidemiology of some peripheral arterial findings in diabetic men and women: Experiences from the Framingham study

Abstract

purpose and patients and methods: The purpose of this study was to determine the relationship between diabetes and the development of some peripheral arterial findings—carotid and femoral bruits and nonpalpable pedal pulse—and acute cardiovascular events in 1,196 men and 1,582 women based on 20-year-follow-up data in the Framingham Study. results: For both men and women without diabetes, the incidence of carotid bruits and nonpalpable pedal pulses increased significantly with age (p <0.05) without any apparent male predominance. In contrast, diabetic men and women were at an elevated risk of each peripheral arterial condition that was not appreciably different across age groups. Compared with women without diabetes, those with diabetes experienced nearly a twofold excess of femoral bruits (p <0.05) and a 50% excess of nonpalpable pedal pulses (p <0.01). Among men, diabetes nearly doubled the risk of carotid bruits (p <0.05). Those who had both diabetes and symptoms of peripheral arterial disease were at especially high risk of incident cardiovascular events. In particular, nonpalpable pedal pulses were associated with more than a twofold excess of coronary heart disease (p <0.05) and stroke (p <0.01) in diabetic women and more than a twofold excess of coronary heart disease and cardiac failure in diabetic men (p <0.01). Femoral bruits doubled the risk of coronary heart disease in diabetic men (p <0.05). conclusion: We conclude that while diabetes predisposes to various forms and locations of peripheral arterial disease, the enhanced risk of acute cardiovascular events experienced by diabetic patients is increased further when diabetes is accompanied by indications of a peripheral arterial condition. Since signs of peripheral arterial disease may suggest an impending or coexistent atherosclerotic process, careful examination of arterial circulation by evaluating peripheral pulses and assessing whether bruits are present is important.