- 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.
- 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.
- 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>
- 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.