title: Peripheral arterial disease, diabetes, and mortality.
abstract: OBJECTIVE
  The aims of this study were to provide estimates of 1) the risk of mortality for individuals with both diabetes and peripheral arterial disease (PAD) relative to that for individuals with either condition alone and 2) the association between PAD progression and mortality for individuals with diabetes, PAD, and both conditions.
  
  
  METHODS
  This longitudinal cohort study was conducted in Rochester, Minnesota. Local residents age 50-70 years with a prior diagnosis of PAD and/or diabetes were identified from the Mayo Clinic diagnostic registry and invited to a baseline examination (1977-1978). Those who met inclusion criteria were assessed for PAD progression at 2 and 4 years and followed for vital status through 31 December 1999.
  
  
  RESULTS
  The numbers who met criteria for PAD, diabetes, and both conditions at baseline were 149, 238, and 186, respectively. Within each group, observed survival was less than expected (P <0.001). The adjusted risk of death for both conditions was 2.2 times that for PAD alone. Among the 449 who returned at 4 years, the risk of subsequent death was greater for those whose PAD had progressed; among individuals with diabetes alone at baseline, 100% (17 of 17) who met criteria for PAD progression were dead by 31 December 1999 compared with 62% (111 of 178) of those who had not met criteria (adjusted relative hazard 2.29 [95% CI 1.30-4.02], P=0.004). The increased mortality associated with PAD progression was significant only for individuals with diabetes (alone or with PAD).
  
  
  CONCLUSIONS
  Diabetes is a risk factor for both PAD and PAD-associated mortality, emphasizing the critical need to detect and monitor PAD in diabetic patients.
authors.affiliation: Department of Health Sciences Research, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA. leibson@mayo.edu
authors.forename: Cynthia L
authors.initials: CL
authors.lastname: Leibson
authors.forename: Jeanine E
authors.initials: JE
authors.lastname: Ransom
authors.forename: Wayne
authors.initials: W
authors.lastname: Olson
authors.forename: Bruce R
authors.initials: BR
authors.lastname: Zimmerman
authors.forename: W Michael
authors.initials: WM
authors.lastname: O'fallon
authors.forename: Pasquale J
authors.initials: PJ
authors.lastname: Palumbo
mesh_terms: D000368:Aged; D001157:Arterial Occlusive Diseases / Q000453:epidemiology* / Q000401:mortality*; D003925:Diabetic Angiopathies / Q000453:epidemiology* / Q000401:mortality; D018450:Disease Progression; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D012307:Risk Factors; D016019:Survival Analysis