Role of systolic blood pressure and plasma triglycerides in diabetic peripheral arterial disease - The Edinburgh Artery Study

OBJECTIVE - To determine the risk factors for peripheral arterial disease ( PAD) in a diabetic population and to examine whether different levels of th ese risk factors might explain why diabetic subjects have an increased risk of PAD compared with normal glucose tolerance subjects. RESEARCH DESIGN AND METHODS - There were 1,592 men and women aged 55-74 yea rs selected at random from the age-sex registers of II general practices in Edinburgh, Scotland. Subjects underwent a comprehensive medical examinatio n, including assessment for PAD (intermittent claudication on World Health Organization questionnaire or major asymptomatic disease on noninvasive tes ting) and a glucose tolerance test. RESULTS - Of the subjects, 288 (18.7%) were found to have diabetes or impai red glucose tolerance (IGT). The prevalence of PAD was greater in those wit h diabetes/IGT (20.6%) compared with those with normal glucose tolerance (1 2.5%) (odds ratio [OR] 1.64, 95% CI 1.17-2.31). Among the diabetes/IGT grou p, mean levels of smoking, systolic blood pressure, and triglycerides were higher in subjects with PAD than in those without PAD (P less than or equal to 0.05). Mean levels of systolic blood pressure and plasma triglycerides were also higher in diabetic subjects than in nondiabetic subjects with PAD (P - 0.05). In multivariate analysis, those with diabetes/IGT no longer ha d a significantly higher risk of PAD after adjusting separately for systoli c blood pressure (OR 1.22, 95% CI 0.85-1.73) and plasma triglycerides (OR 1 .26, 95% CI 0.89-1.79). Simultaneous adjustment for both systolic brood pre ssure and triglycerides reduced the risk of PAD among diabetic subjects to 1.11 (95% CI 0.78-1.58). CONCLUSIONS - Increased mean levels of triglycerides and systolic blood pre ssure may help to explain the higher prevalence of PAD in diabetic subjects compared with that in normal glucose tolerance subjects.