Glycemic control, lipid-lowering treatment, and prognosis in diabetic patients with peripheral atherosclerotic disease.
Glycemic control may be an underestimated risk factor in diabetic patients with peripheral arterial disease (PAD). Chronic statin therapy may improve glycemic control and outcome in these patients. In an observational cohort study of 425 consecutive diabetic patients with PAD, chronic statin therapy was noted, the ankle-brachial index was measured, and serial glycemic hemoglobin (HbA(1c)) measurements were obtained. During follow-up (median 7 years), all-cause mortality and cardiac death occurred in 37% and 22%, respectively. Decreases in HbA(1c) and HbA(1c) variability independently predicted outcome in addition to baseline ankle-brachial index values. Patients with chronic statin therapy were more likely to have decreasing HbA(1c) values (adjusted hazard ratio [HR]= 1.86, 95% confidence interval [CI] 1.27-2.74) and HbA(1c) values <7% (adjusted HR = 2.58, 95% CI 1.49-4.48) during follow-up. Statins were also significantly associated with lower all-cause mortality (adjusted HR = 0.39, 95% CI 0.26-0.61) and cardiac death rate (adjusted HR = 0.40, 95% CI 0.24-76). Based on the results of the current observational study, we conclude that serial HbA(1c) measurements can improve risk stratification in diabetic patients with PAD. In addition, statin therapy is associated with desirable glycemic control and improved long-term outcome.
Feringa
Harm H H
HH
Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands.
Karagiannis
Stefanos E
SE
Vidakovic
Radosav
R
Elhendy
Abdou
A
Schouten
Olaf
O
Boersma
Eric
E
Bax
Jeroen J
JJ
Poldermans
Don
D
D000842:Ankle / Q000098:blood supply; D050197:Atherosclerosis / Q000097:blood / Q000150:complications / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D001794:Blood Pressure; D001916:Brachial Artery / Q000503:physiopathology; D048909:Diabetes Complications / Q000097:blood / Q000188:drug therapy / Q000209:etiology* / Q000401:mortality; D003920:Diabetes Mellitus / Q000097:blood / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006331:Heart Diseases / Q000097:blood / Q000188:drug therapy / Q000209:etiology* / Q000401:mortality; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D053208:Kaplan-Meier Estimate; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000097:blood / Q000150:complications / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
D006442:Glycated Hemoglobin; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D007004:Hypoglycemic Agents; C517652:hemoglobin A1c protein, human