Mortality rates at 10 years are higher in diabetic than in non-diabetic patients with chronic lower extremity peripheral arterial disease

Thomas Mueller, Franz Hinterreiter, Werner Poelz, Meinhard Haltmayer, Benjamin Dieplinger, Thomas Mueller, Franz Hinterreiter, Werner Poelz, Meinhard Haltmayer, Benjamin Dieplinger

Abstract

Patients with lower extremity peripheral artery disease (PAD) have a substantially increased risk for mortality as compared to healthy individuals. We aimed to evaluate the risk for all-cause mortality in PAD patients and in healthy controls during a 10-year follow-up period. Our hypothesis was that the mortality rates at 10 years would differ in diabetic and non-diabetic PAD patients. Our study group consisted of 331 consecutive patients with symptomatic PAD <75 years of age admitted to a tertiary care hospital, including 216 patients without diabetes and 115 with diabetes. Control subjects without atherosclerotic disease were matched to the patients in a 1:1 design by sex, age, and diabetes mellitus status. The outcome measure was all-cause mortality at 10 years. Mortality rates at 10 years were 29% in non-diabetic PAD patients versus 14% in age- and sex-matched non-diabetic controls (risk ratio (RR), 2.31; 95% confidence interval (CI), 1.54-3.47; p<0.001), and 58% in diabetic PAD patients versus 19% in age- and sex-matched diabetic controls (RR, 4.06; 95% CI, 2.67-6.18; p<0.001). Further, PAD patients with diabetes had a significantly increased risk for death within 10 years than did the non-diabetic PAD patients (RR, 2.51; 95% CI, 1.72-3.66; p<0.001). Diabetes was independently associated with outcome, and was the strongest predictor of death in multivariate Cox proportional hazards regression. We conclude that mortality rates at 10 years differ in PAD patients <75 years old with and without diabetes. Our findings suggest that future studies should apply distinct risk assessment strategies in the two PAD subgroups.

Keywords: atherosclerosis; diabetes mellitus; mortality; peripheral artery disease; prognosis.

Conflict of interest statement

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

© The Author(s) 2016.

Figures

Figure 1.
Figure 1.
Kaplan-Meier plot showing survival in 331 patients with symptomatic peripheral artery disease (PAD) according to the two patient groups (i.e. 216 patients without diabetes mellitus vs 115 patients with diabetes mellitus).
Figure 2.
Figure 2.
Kaplan-Meier plots showing survival in (A) 216 non-diabetic peripheral artery disease (PAD) patients and 216 age- and sex-matched non-diabetic controls and (B) 115 diabetic PAD patients and 115 age- and sex-matched diabetic controls.

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