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HbA1c and peripheral arterial disease in diabetes: the Atherosclerosis Risk in Communities study.

TitleHbA1c and peripheral arterial disease in diabetes: the Atherosclerosis Risk in Communities study.
Publication TypeJournal Article
Year of Publication2006
AuthorsSelvin E, Wattanakit K, Steffes MW, Coresh J, A Sharrett R
JournalDiabetes Care
Volume29
Issue4
Pagination877-82
Date Published2006 Apr
ISSN0149-5992
KeywordsCohort Studies, Diabetes Mellitus, Diabetic Angiopathies, Educational Status, Female, Glycated Hemoglobin A, Hospitalization, Humans, Hypoglycemic Agents, Intermittent Claudication, Male, Middle Aged, Peripheral Vascular Diseases, Prospective Studies, Risk Factors, Smoking
Abstract

OBJECTIVE: To assess the relation between HbA(1c) (A1C) and incident peripheral arterial disease (PAD) in a community-based cohort of diabetic adults from the Atherosclerosis Risk in Communities (ARIC) study. A second aim was to investigate whether the association was stronger for severe, symptomatic disease compared with PAD assessed by low ankle-brachial index (ABI).

RESEARCH DESIGN AND METHODS: This was a prospective cohort study of 1,894 individuals with diabetes using ARIC visit 2 as baseline (1990-1992) with follow-up for incident PAD through 2002. We assessed the relation between A1C and incident PAD, defined by intermittent claudication, PAD-related hospitalization, or a low ABI (

RESULTS: During a mean follow-up of 9.8 years, the crude incidence rates were 2.1 per 1,000 person-years for intermittent claudication (n = 41), 2.9 per 1,000 person-years for PAD-related hospitalization (n = 57), and 18.9 per 1,000 person-years for low ABI at visit 3 or 4 (n = 123). The relative risk (RR) (95% CI) of an incident PAD event comparing the second and third tertiles of A1C to the first, respectively, after adjustment for cardiovascular risk factors was strongest for severe, symptomatic forms of disease, e.g., PAD-related hospitalization (RR = 4.56 [1.86-11.18] for the third A1C tertile compared with the first, P trend

CONCLUSIONS: We found a positive, graded, and independent association between A1C and PAD risk in diabetic adults. This association was stronger for clinical (symptomatic) PAD, whose manifestations may be related to microvascular insufficiency, than for low ABI. Our results suggest that efforts to improve glycemic control in persons with diabetes may substantially reduce the risk of PAD.

DOI10.2337/diacare.29.04.06.dc05-2018
Alternate JournalDiabetes Care
PubMed ID16567831
Grant ListN01-HC-55015 / HC / NHLBI NIH HHS / United States
N01-HC-55016 / HC / NHLBI NIH HHS / United States
N01-HC-55018 / HC / NHLBI NIH HHS / United States
N01-HC-55019 / HC / NHLBI NIH HHS / United States
N01-HC-55020 / HC / NHLBI NIH HHS / United States
N01-HC-55021 / HC / NHLBI NIH HHS / United States
N01-HC-55022 / HC / NHLBI NIH HHS / United States
T32HL07024 / HL / NHLBI NIH HHS / United States