title: Diabetes mellitus, smoking, and the risk for asymptomatic peripheral arterial disease: whom should we screen?
abstract: 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.
authors.affiliation: 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.
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Eason
authors.forename: Nancy J
authors.initials: NJ
authors.lastname: Petersen
authors.forename: Maria
authors.initials: M
authors.lastname: Suarez-Almazor
authors.forename: Barry
authors.initials: B
authors.lastname: Davis
authors.forename: Tracie C
authors.initials: TC
authors.lastname: Collins
mesh_terms: 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