title: Peripheral neuropathy and the risk of cardiovascular events in type 2 diabetes mellitus.
abstract: OBJECTIVE
  Identifying individuals with diabetes at high risk of cardiovascular disease (CVD) remains challenging. We aimed to establish whether peripheral neuropathy (PN) is associated with incident CVD events and to what extent information on PN may improve risk prediction among individuals with type 2 diabetes.
  
  
  METHODS
  We obtained data for individuals with type 2 diabetes, and free of CVD, from a large primary care patient cohort. Incident CVD events were recorded during a 30-month follow-up period. Eligible individuals had complete ascertainment of cardiovascular risk factors and PN status at baseline. The association between PN and incident CVD events (non-fatal myocardial infarction, coronary revascularisation, congestive cardiac failure, transient ischaemic attack and stroke) was evaluated using Cox regression, adjusted for standard CVD risk factors. We assessed the predictive accuracy of models including conventional CVD risk factors with and without information on PN.
  
  
  RESULTS
  Among 13 043 eligible individuals, we recorded 407 deaths from any cause and 399 non-fatal CVD events. After adjustment for age, sex, ethnicity, systolic blood pressure, cholesterol, body mass index, HbA1c, smoking status and use of statin or antihypertensive medication, PN was associated with incident CVD events (HR 1.33; 95% CI 1.02 to 1.75, p=0.04). The addition of information on PN to a model based on standard CVD risk factors resulted in modest improvements in discrimination for CVD risk prediction and reclassified 6.9% of individuals into different risk categories.
  
  
  CONCLUSIONS
  PN is associated with increased risk for a first cardiovascular event among individuals with diabetes.
authors.affiliation: St George's Vascular Institute, Division of Cardiovascular Sciences, St Georges University of London, UK.
authors.forename: Jack R W
authors.initials: JR
authors.lastname: Brownrigg
authors.affiliation: Department of Health Care Management and Policy, University of Surrey, Guildford, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: de Lusignan
authors.affiliation: Department of Health Care Management and Policy, University of Surrey, Guildford, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: McGovern
authors.affiliation: St George's Vascular Institute, Division of Cardiovascular Sciences, St Georges University of London, UK.
authors.forename: Cian
authors.initials: C
authors.lastname: Hughes
authors.affiliation: St George's Vascular Institute, Division of Cardiovascular Sciences, St Georges University of London, UK.
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Thompson
authors.affiliation: St George's Vascular Institute, Division of Cardiovascular Sciences, St Georges University of London, UK.
authors.forename: Kausik K
authors.initials: KK
authors.lastname: Ray
authors.affiliation: St George's Vascular Institute, Division of Cardiovascular Sciences, St Georges University of London, UK.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Hinchliffe
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D003929:Diabetic Neuropathies / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010523:Peripheral Nervous System Diseases / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D011379:Prognosis; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult