Diabetes and vascular disease in different arterial territories.
OBJECTIVE
The aim of this study was to investigate the relationship between diabetes and different phenotypes of peripheral vascular disease (lower extremity peripheral artery disease [PAD], carotid artery stenosis [CAS], and abdominal aortic aneurysm [AAA]).


METHODS
Prevalence of vascular disease was evaluated in 3,696,778 participants of the Life Line Screening survey between 2003 and 2008. PAD was defined as ankle-brachial pressure index <0.90 or prior revascularization, CAS as ≥50% stenosis or prior revascularization, and AAA as infrarenal aortic diameter ≥3 cm or prior repair. Odds ratios (ORs) and 95% CIs were assessed using logistic regression modeling.


RESULTS
Diabetes mellitus was present in 10.8% of participants (n = 399,884). Prevalence of PAD, CAS, and AAA was significantly higher (P < 0.0001) in participants with compared with those without diabetes. After multivariate adjustment for baseline demographics and clinical risk factors, a significant interaction existed between diabetes and vascular disease phenotype (P < 0.0001). Diabetes was associated with increased odds of PAD (OR 1.42 [95% CI 1.41-1.4]; P < 0.0001) and CAS (1.45 [1.43-1.47]; P < 0.0001) but decreased odds of AAA (0.86 [0.84-0.88]; P < 0.0001). The strength of association increased with increasing severity of disease in each vascular phenotype, and this association persisted in the population with asymptomatic vascular disease.


CONCLUSIONS
In a large population-based study, the association between diabetes and vascular disease differed according to vascular phenotype. Future studies exploring the mechanism for these vascular-specific differences are needed.
Department of Medicine, Division of Cardiology, New York University School of Medicine, New York, NY.
Binita
B
Shah
Department of Surgery, Division of Vascular Surgery, New York University School of Medicine, New York, NY.
Caron B
CB
Rockman
Department of Population Health, Division of Biostatistics, New York University School of Medicine, New York, NY.
Yu
Y
Guo
Department of Medicine, Division of Cardiology, New York University School of Medicine, New York, NY.
Jaclyn
J
Chesner
Department of Medicine, Division of Cardiology, New York University School of Medicine, New York, NY.
Arthur Z
AZ
Schwartzbard
Department of Medicine, Division of Cardiology, New York University School of Medicine, New York, NY.
Howard S
HS
Weintraub
Department of Surgery, Division of Vascular Surgery, New York University School of Medicine, New York, NY.
Mark A
MA
Adelman
Department of Surgery, Division of Vascular Surgery, New York University School of Medicine, New York, NY.
Thomas S
TS
Riles
Department of Medicine, Division of Cardiology, New York University School of Medicine, New York, NYDepartment of Surgery, Division of Vascular Surgery, New York University School of Medicine, New York, NYDepartment of Medicine, Division of Hematology, New York University School of Medicine, New York, NY jeffrey.berger@nyumc.org.
Jeffrey S
JS
Berger
D055109:Ankle Brachial Index; D017544:Aortic Aneurysm, Abdominal / Q000453:epidemiology*; D016893:Carotid Stenosis / Q000453:epidemiology*; D003920:Diabetes Mellitus / Q000503:physiopathology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D035002:Lower Extremity / Q000473:pathology*; D008297:Male; D009518:New York / Q000453:epidemiology; D016017:Odds Ratio; D016491:Peripheral Vascular Diseases / Q000453:epidemiology*; D015995:Prevalence; D012307:Risk Factors