Prevalence and Prognostic Significance of Asymptomatic Peripheral Arterial Disease in 68-year-old Men with Diabetes. Results from the Population Study ‘Men Born in 1914’ from Malmö, Sweden

Abstract

Objective To assess the prevalence of asymptomatic peripheral arterial disease (PAD) in older men with diabetes and to compare the incidence of cardiac events and deaths in diabetic and non-diabetic men with abnormal and normal systolic ankle–brachial pressure index, respectively. Research design and methods Population-based cohort of 68-year-old men ( n=474). Diabetes was defined as history of diabetes or a fasting blood glucose ≥6.1 mmol/l. PAD was defined as an ankle–brachial pressure index (ABI) <0.9 in either leg. Fourteen-year mortality and cardiac event rates were based on record linkage with regional and national registers. Results The prevalence of PAD in men with and without diabetes was 29 and 12%, respectively ( p=0.003). The incidence of cardiac events was 22.9/1000 person years in men free from both diabetes and PAD. In the absence of an abnormal pressure index, diabetes was associated with an event rate of 28.4 ( p=0.469). In the presence of an abnormal index the incidence was 102 ( p<0.001). This pattern remained in the multivariate analysis when other atherosclerotic risk factors were taken into account. Cardiovascular mortality rates similarly differed substantially between diabetic men with and without PAD. Conclusions A fasting blood glucose value above 6.1 mmol/l even in the absence of symptoms indicating diabetes was associated by an increased prevalence of asymptomatic PAD. The cardiovascular risk in diabetes varied widely between men with and without abnormal ankle–brachial pressure index.