Absence of peripheral pulses and risk of major vascular outcomes in patients with type 2 diabetes

Kamel Mohammedi, Mark Woodward, Sophia Zoungas, Qiang Li, Stephen Harrap, Anushka Patel, Michel Marre, John Chalmers

Research output: Contribution to journalArticle

Abstract

OBJECTIVE The burden of vascular diseases remains substantial in patients with type 2 diabetes, requiring identification of further risk markers. We tested the absence of dorsalis pedis and posterior tibial pulses as predictors ofmajormacrovascular and microvascular events, death, and cognitive decline in this population. RESEARCH DESIGN AND METHODS Data were derived from 11,120 patients with type 2 diabetes in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified-Release Controlled Evaluation (ADVANCE) study. Absent peripheral pulses at baseline were defined as absence of at least one dorsalis pedis or posterior tibial pulse. RESULTS Absent compared with present peripheral pulses (n = 2,218) were associated with increased 5-year risks for major macrovascular events (hazard ratio 1.47 [95% CI 1.28-1.69], P < 0.0001), myocardial infarction (1.45 [1.13-1.87], P = 0.003), stroke (1.57 [1.23-2.00], P = 0.0003), cardiovascular death (1.61 [1.33-1.95], P < 0.0001), heart failure (1.49 [1.21-1.84], P = 0.0002), all-cause mortality (1.48 [1.29-1.71], P < 0.0001), major microvascular events (1.17 [1.00-1.36], P = 0.04), nephropathy (1.24 [1.00-1.54], P = 0.04), end-stage renal disease or renal death (2.04 [1.12-3.70], P = 0.02), and peripheral neuropathy (1.13 [1.05-1.21], P = 0.0008) after multiple adjustment. Participants with absent dorsalis pedis or posterior tibial pulses had comparable hazard ratios. Risks increased proportionally with the number of absent peripheral pulses, with the highest risks observed in patients with three or four absent pulses. Every additional absent pulse increases the risk of all outcomes. CONCLUSIONS Absent dorsalis pedis and/or posterior tibial pulses are independent predictors of major vascular outcomes in patients with type 2 diabetes. These simple clinical indicators should be used to improve risk stratification and treatment of these patients.

Original languageEnglish (US)
Pages (from-to)2270-2277
Number of pages8
JournalDiabetes Care
Volume39
Issue number12
DOIs
StatePublished - 2016

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Type 2 Diabetes Mellitus
Blood Vessels
perindopril drug combination indapamide
Vascular Diseases
Gliclazide
Social Adjustment
Peripheral Nervous System Diseases
Chronic Kidney Failure
Heart Failure
Stroke
Myocardial Infarction
Kidney
Mortality
Population

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing

Cite this

Mohammedi, K., Woodward, M., Zoungas, S., Li, Q., Harrap, S., Patel, A., ... Chalmers, J. (2016). Absence of peripheral pulses and risk of major vascular outcomes in patients with type 2 diabetes. Diabetes Care, 39(12), 2270-2277. https://doi.org/10.2337/dc16-1594

Absence of peripheral pulses and risk of major vascular outcomes in patients with type 2 diabetes. / Mohammedi, Kamel; Woodward, Mark; Zoungas, Sophia; Li, Qiang; Harrap, Stephen; Patel, Anushka; Marre, Michel; Chalmers, John.

In: Diabetes Care, Vol. 39, No. 12, 2016, p. 2270-2277.

Research output: Contribution to journalArticle

Mohammedi, K, Woodward, M, Zoungas, S, Li, Q, Harrap, S, Patel, A, Marre, M & Chalmers, J 2016, 'Absence of peripheral pulses and risk of major vascular outcomes in patients with type 2 diabetes', Diabetes Care, vol. 39, no. 12, pp. 2270-2277. https://doi.org/10.2337/dc16-1594
Mohammedi, Kamel ; Woodward, Mark ; Zoungas, Sophia ; Li, Qiang ; Harrap, Stephen ; Patel, Anushka ; Marre, Michel ; Chalmers, John. / Absence of peripheral pulses and risk of major vascular outcomes in patients with type 2 diabetes. In: Diabetes Care. 2016 ; Vol. 39, No. 12. pp. 2270-2277.
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abstract = "OBJECTIVE The burden of vascular diseases remains substantial in patients with type 2 diabetes, requiring identification of further risk markers. We tested the absence of dorsalis pedis and posterior tibial pulses as predictors ofmajormacrovascular and microvascular events, death, and cognitive decline in this population. RESEARCH DESIGN AND METHODS Data were derived from 11,120 patients with type 2 diabetes in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified-Release Controlled Evaluation (ADVANCE) study. Absent peripheral pulses at baseline were defined as absence of at least one dorsalis pedis or posterior tibial pulse. RESULTS Absent compared with present peripheral pulses (n = 2,218) were associated with increased 5-year risks for major macrovascular events (hazard ratio 1.47 [95{\%} CI 1.28-1.69], P < 0.0001), myocardial infarction (1.45 [1.13-1.87], P = 0.003), stroke (1.57 [1.23-2.00], P = 0.0003), cardiovascular death (1.61 [1.33-1.95], P < 0.0001), heart failure (1.49 [1.21-1.84], P = 0.0002), all-cause mortality (1.48 [1.29-1.71], P < 0.0001), major microvascular events (1.17 [1.00-1.36], P = 0.04), nephropathy (1.24 [1.00-1.54], P = 0.04), end-stage renal disease or renal death (2.04 [1.12-3.70], P = 0.02), and peripheral neuropathy (1.13 [1.05-1.21], P = 0.0008) after multiple adjustment. Participants with absent dorsalis pedis or posterior tibial pulses had comparable hazard ratios. Risks increased proportionally with the number of absent peripheral pulses, with the highest risks observed in patients with three or four absent pulses. Every additional absent pulse increases the risk of all outcomes. CONCLUSIONS Absent dorsalis pedis and/or posterior tibial pulses are independent predictors of major vascular outcomes in patients with type 2 diabetes. These simple clinical indicators should be used to improve risk stratification and treatment of these patients.",
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T1 - Absence of peripheral pulses and risk of major vascular outcomes in patients with type 2 diabetes

AU - Mohammedi, Kamel

AU - Woodward, Mark

AU - Zoungas, Sophia

AU - Li, Qiang

AU - Harrap, Stephen

AU - Patel, Anushka

AU - Marre, Michel

AU - Chalmers, John

PY - 2016

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N2 - OBJECTIVE The burden of vascular diseases remains substantial in patients with type 2 diabetes, requiring identification of further risk markers. We tested the absence of dorsalis pedis and posterior tibial pulses as predictors ofmajormacrovascular and microvascular events, death, and cognitive decline in this population. RESEARCH DESIGN AND METHODS Data were derived from 11,120 patients with type 2 diabetes in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified-Release Controlled Evaluation (ADVANCE) study. Absent peripheral pulses at baseline were defined as absence of at least one dorsalis pedis or posterior tibial pulse. RESULTS Absent compared with present peripheral pulses (n = 2,218) were associated with increased 5-year risks for major macrovascular events (hazard ratio 1.47 [95% CI 1.28-1.69], P < 0.0001), myocardial infarction (1.45 [1.13-1.87], P = 0.003), stroke (1.57 [1.23-2.00], P = 0.0003), cardiovascular death (1.61 [1.33-1.95], P < 0.0001), heart failure (1.49 [1.21-1.84], P = 0.0002), all-cause mortality (1.48 [1.29-1.71], P < 0.0001), major microvascular events (1.17 [1.00-1.36], P = 0.04), nephropathy (1.24 [1.00-1.54], P = 0.04), end-stage renal disease or renal death (2.04 [1.12-3.70], P = 0.02), and peripheral neuropathy (1.13 [1.05-1.21], P = 0.0008) after multiple adjustment. Participants with absent dorsalis pedis or posterior tibial pulses had comparable hazard ratios. Risks increased proportionally with the number of absent peripheral pulses, with the highest risks observed in patients with three or four absent pulses. Every additional absent pulse increases the risk of all outcomes. CONCLUSIONS Absent dorsalis pedis and/or posterior tibial pulses are independent predictors of major vascular outcomes in patients with type 2 diabetes. These simple clinical indicators should be used to improve risk stratification and treatment of these patients.

AB - OBJECTIVE The burden of vascular diseases remains substantial in patients with type 2 diabetes, requiring identification of further risk markers. We tested the absence of dorsalis pedis and posterior tibial pulses as predictors ofmajormacrovascular and microvascular events, death, and cognitive decline in this population. RESEARCH DESIGN AND METHODS Data were derived from 11,120 patients with type 2 diabetes in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified-Release Controlled Evaluation (ADVANCE) study. Absent peripheral pulses at baseline were defined as absence of at least one dorsalis pedis or posterior tibial pulse. RESULTS Absent compared with present peripheral pulses (n = 2,218) were associated with increased 5-year risks for major macrovascular events (hazard ratio 1.47 [95% CI 1.28-1.69], P < 0.0001), myocardial infarction (1.45 [1.13-1.87], P = 0.003), stroke (1.57 [1.23-2.00], P = 0.0003), cardiovascular death (1.61 [1.33-1.95], P < 0.0001), heart failure (1.49 [1.21-1.84], P = 0.0002), all-cause mortality (1.48 [1.29-1.71], P < 0.0001), major microvascular events (1.17 [1.00-1.36], P = 0.04), nephropathy (1.24 [1.00-1.54], P = 0.04), end-stage renal disease or renal death (2.04 [1.12-3.70], P = 0.02), and peripheral neuropathy (1.13 [1.05-1.21], P = 0.0008) after multiple adjustment. Participants with absent dorsalis pedis or posterior tibial pulses had comparable hazard ratios. Risks increased proportionally with the number of absent peripheral pulses, with the highest risks observed in patients with three or four absent pulses. Every additional absent pulse increases the risk of all outcomes. CONCLUSIONS Absent dorsalis pedis and/or posterior tibial pulses are independent predictors of major vascular outcomes in patients with type 2 diabetes. These simple clinical indicators should be used to improve risk stratification and treatment of these patients.

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