PAD and DM add up to high risk for CV and limb events

  • J Am Coll Cardiol

  • curated by Miriam Tucker
  • Clinical Essentials
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Takeaway

  • Risk for cardiovascular and limb ischemic events is elevated among patients with symptomatic peripheral arterial disease (PAD) and diabetes mellitus (DM), even with contemporary therapies.
  • Major adverse cardiovascular event (MACE) risk rises with higher HbA1c.

Why this matters

  • Patients with diabetes and PAD have worse outcomes including amputations and mortality.

Study design

  • In the EUCLID (Examining Use of Ticagrelor in Peripheral Artery Disease) trial of 13,885 patients with symptomatic PAD, primary endpoint was adjudicated MACE composite (cardiovascular death, myocardial infarction, ischemic stroke).
  • Subanalysis of outcomes in the 5345 (38.5%) with diabetes (96% type 2) vs those without.
  • Funding: AstraZeneca.

Key results

  • Cumulative incidence of primary endpoint by 36 months occurred in 15.9% with diabetes vs 10.4% without (adjusted HR, 1.41; P<.0001 with significant difference in each individual component.>
  • Diabetes group had significant increases in major amputation (96%; P<.0001 lower extremity revascularization and carotid>
  • For every percentage point difference in baseline HbA1c, there was a 14.2% increase in the primary outcome (HR, 1.142; P<.0001>

Limitations

  • Diabetes was a study subgroup (although prespecified).
  • Some diabetes-related data missing.  
  • Cannot extrapolate findings to patients with asymptomatic PAD, or with ankle-brachial index >0.80.

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