Absence of Peripheral Pulses and Risk of Major Vascular Outcomes in Patients With Type 2 Diabetes.
The burden of vascular diseases remains substantial in patients with type 2 diabetes, requiring identification of further risk markers. We tested the absence of dorsalis pedis and posterior tibial pulses as predictors of major macrovascular and microvascular events, death, and cognitive decline in this population.



Data were derived from 11,120 patients with type 2 diabetes in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified-Release Controlled Evaluation (ADVANCE) study. Absent peripheral pulses at baseline were defined as absence of at least one dorsalis pedis or posterior tibial pulse.



Absent compared with present peripheral pulses (n = 2,218) were associated with increased 5-year risks for major macrovascular events (hazard ratio 1.47 [95% CI 1.28-1.69], P < 0.0001), myocardial infarction (1.45 [1.13-1.87], P = 0.003), stroke (1.57 [1.23-2.00], P = 0.0003), cardiovascular death (1.61 [1.33-1.95], P < 0.0001), heart failure (1.49 [1.21-1.84], P = 0.0002), all-cause mortality (1.48 [1.29-1.71], P < 0.0001), major microvascular events (1.17 [1.00-1.36], P = 0.04), nephropathy (1.24 [1.00-1.54], P = 0.04), end-stage renal disease or renal death (2.04 [1.12-3.70], P = 0.02), and peripheral neuropathy (1.13 [1.05-1.21], P = 0.0008) after multiple adjustment. Participants with absent dorsalis pedis or posterior tibial pulses had comparable hazard ratios. Risks increased proportionally with the number of absent peripheral pulses, with the highest risks observed in patients with three or four absent pulses. Every additional absent pulse increases the risk of all outcomes.



Absent dorsalis pedis and/or posterior tibial pulses are independent predictors of major vascular outcomes in patients with type 2 diabetes. These simple clinical indicators should be used to improve risk stratification and treatment of these patients.
The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia.
Kamel
K
Mohammedi
The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia.|The George Institute for Global Health, University of Oxford, Oxford, U.K.|Department of Epidemiology, Johns Hopkins University, Baltimore, MD.
Mark
M
Woodward
The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia.|Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia.
Sophia
S
Zoungas
The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia.
Qiang
Q
Li
The University of Melbourne and Royal Melbourne Hospital, Melbourne, Victoria, Australia.
Stephen
S
Harrap
The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia.
Anushka
A
Patel
INSERM, UMRS 1138, Centre de Recherche des Cordeliers, Paris, France.|Department of Diabetology, Endocrinology and Nutrition, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, DHU FIRE, Paris, France.|Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine, Paris, France.
Michel
M
Marre
The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia chalmers@georgeinstitute.org.au.
John
J
Chalmers
D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology*; D003925:Diabetic Angiopathies / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology; D003935:Diagnostic Techniques, Cardiovascular; D018450:Disease Progression; D004338:Drug Combinations; D005260:Female; D005907:Gliclazide / Q000008:administration & dosage; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D007190:Indapamide / Q000008:administration & dosage; D007676:Kidney Failure, Chronic / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy / Q000503:physiopathology; D020913:Perindopril / Q000008:administration & dosage; D011674:Pulse; D012307:Risk Factors; D020521:Stroke / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy
D004338:Drug Combinations; D007004:Hypoglycemic Agents; C494243:indapamide, perindopril drug combination; D007190:Indapamide; D005907:Gliclazide; D020913:Perindopril