Diabetes mellitus, smoking, and the risk for asymptomatic peripheral arterial disease: whom should we screen?
OBJECTIVE
To describe coexisting medical conditions and lifestyle factors associated with asymptomatic peripheral arterial disease (PAD) in a population of white, African American, and Hispanic patients.


METHODS
White, African American, and Hispanic patients 50 years or older were recruited for this cross-sectional study from 4 primary care clinics in Houston, TX. Patients with an ankle-brachial index (ABI) < 0.9 and without leg symptoms typical of PAD were diagnosed with asymptomatic PAD.


RESULTS
403 patients were screened for PAD. Of these, 25 (6.2%) had asymptomatic PAD. Compared with patients without PAD, diabetes mellitus ([OR] 3.8; 95% CI 1.6, 9.0) and a history of smoking at least 1 pack of cigarettes per day ([OR] 2.5; 95% CI 1.1, 6.0) were significantly associated with asymptomatic PAD. An interaction effect existed between diabetes mellitus and smoking at least 1 pack of cigarettes per day. Diabetes mellitus combined with heavy smoking showed the highest predicted value positive (15%) and the highest specificity (92%). A lack of both demonstrated low rates for predicting asymptomatic PAD (predicted value positive, 1%).


CONCLUSIONS
The ankle-brachial index could become routine screening among patients with diabetes mellitus and/or who smoke.
Eason
Sharon L
SL
Houston Center for Quality of Care and Utilization Studies, Houston Veterans Affairs Medical Center, Section of Health Services Research, Baylor College of Medicine, Houston, TX 77021, USA.
Petersen
Nancy J
NJ
Suarez-Almazor
Maria
M
Davis
Barry
B
Collins
Tracie C
TC
D000368:Aged; D000369:Aged, 80 and over; D001916:Brachial Artery / Q000503:physiopathology; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000503:physiopathology; D003925:Diabetic Angiopathies / Q000175:diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology; D012039:Regional Blood Flow; D018570:Risk Assessment; D012907:Smoking / Q000453:epidemiology* / Q000503:physiopathology