title: Development of new peripheral arterial occlusive disease in patients with type 2 diabetes during a mean follow-up of 11 years.
abstract: OBJECTIVE
  To assess the occurrence and development of new peripheral arterial occlusive disease (PAOD), its risk factors, and the outcome in patients with type 2 diabetes.
  
  
  METHODS
  A total of 130 type 2 diabetic patients (mean age 58 years) were examined at baseline and after a mean follow-up of 11 years (range 7-14). The ankle-brachial index (ABI) and toe-brachial index were used to detect PAOD. Blood and urine samples were taken at baseline, and a history of cardiovascular events was recorded during follow-up.
  
  
  RESULTS
  PAOD was diagnosed in 21 (16%) patients at baseline. During follow-up, 21 of 89 (24%) patients developed new PAOD. There were 29 patients who died, 21 (72%) of them from cardiovascular disease. Patients with PAOD suffered an excess mortality compared with patients without PAOD (58 vs. 16%; P < 0.001). Logistic regression analysis showed that PAOD at baseline was associated with age, duration of diabetes, smoking, and urinary albumin excretion rate. Patients who developed new PAOD during follow-up had higher serum LDL cholesterol concentrations and lower HDL cholesterol concentrations and were older than the patients who remained free of PAOD.
  
  
  CONCLUSIONS
  Objectively measured PAOD is frequent in type 2 diabetic patients. It presents the early clinical signs of atherosclerosis and is strongly associated with cardiovascular death. The risk factor pattern for PAOD was different at baseline and after a mean follow-up of 11 years. We consider routine ABI measurements and modification of risk factors necessary also in patients with asymptomatic PAOD.
authors.affiliation: Department of Vascular Surgery, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Milla
authors.initials: M
authors.lastname: Kallio
authors.forename: Carol
authors.initials: C
authors.lastname: Forsblom
authors.forename: Per-Henrik
authors.initials: PH
authors.lastname: Groop
authors.forename: Leif
authors.initials: L
authors.lastname: Groop
authors.forename: Mauri
authors.initials: M
authors.lastname: Lepäntalo
mesh_terms: D017668:Age of Onset; D001157:Arterial Occlusive Diseases / Q000453:epidemiology*; D001916:Brachial Artery / Q000503:physiopathology; D002096:C-Peptide / Q000097:blood; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000401:mortality; D002784:Cholesterol / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D003925:Diabetic Angiopathies / Q000453:epidemiology*; D018450:Disease Progression; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000453:epidemiology*; D012907:Smoking; D015996:Survival Rate; D013997:Time Factors; D014280:Triglycerides / Q000097:blood
chemical_list: D002096:C-Peptide; D014280:Triglycerides; D002784:Cholesterol