Elsevier

Atherosclerosis

Volume 190, Issue 1, January 2007, Pages 84-89
Atherosclerosis

Association of glucose metabolism, smoking and cardiovascular risk factors with incident peripheral arterial disease: The DESIR study

https://doi.org/10.1016/j.atherosclerosis.2006.02.017Get rights and content

Abstract

Aims

We determined the 6-year incidence of peripheral arterial disease (PAD) in a French population and assessed the association of glucose metabolism, smoking, cardiovascular risk factors and physical activity with incident PAD.

Methods

Participants from the French Data from a Epidemiological Study on the Insulin Resistance Syndrome (DESIR) were studied. Participants analysed were 30–65 years (at baseline) and had complete data (n = 3805) after 6 years of follow-up. Diabetes was diagnosed according to the 1999 WHO criteria on the basis of fasting plasma glucose results or previous diagnosis of diabetes mellitus. The ankle brachial pressure index (ABPI) and a claudication question were used to classify PAD.

Results

The 6-year incidence of PAD (defined by ABPI < 0.9 and or claudication present) among those with normal fasting glucose (NFG) and free of PAD at baseline was 5.1%. Among those with impaired fasting glucose (IFG) at baseline the incidence of PAD was 4.9% and among those with diabetes mellitus at baseline the incidence of PAD was 9.8%. The incidence of PAD among those who maintained NFG over 6 years was 4.7% and among those who progressed to diabetes over 6 years was 10.2%. Those who progressed from NFG or IFG to diabetes over 6 years were twice as likely to develop PAD compared to those who maintained NFG over 6 years, after adjustment for age and sex (OR (95% CI), 2.22 (1.12–4.42)). Independent risk factors for incident PAD using baseline population characteristics were diabetes (OR (95% CI) 2.11 (1.25–3.55)), systolic BP 122–135 mmHg 1.06 (0.70–1.60), >135 mmHg 1.54 (1.04–2.27) and current smoking 1.60 (1.10–2.34) after multivariate adjustment for age, sex, cholesterol, triglycerides and waist circumference.

Conclusions

This French study shows that those who progress to diabetes are twice as likely to develop PAD, compared to those who maintain NFG. Peripheral arterial disease is a treatable condition and more aggressive management of atherosclerotic risk factors could reduce the numbers of people who develop PAD.

Section snippets

Sample selection

This study is based on data collected from a French cohort, Data from an Epidemiological Study of the Insulin Resistance Syndrome (DESIR). The population, methods and response rate of the DESIR study are found in detail elsewhere [13]. In brief, the DESIR study was based on a volunteer population from 10 health examination centres in the western central part of France. Participants were insured by the French Social Security system, which offers periodic health examinations free of charge. The

Results

The incidence of PAD by diabetes status is shown in Table 1. Among those with normal fasting glucose (NFG) and free of PAD at baseline, the 6-year incidence of PAD (defined by ABPI < 0.9 and or claudication present) was 5.1%. In those with IFG at baseline the incidence of PAD was 4.9% and among those with diabetes at baseline the incidence of PAD was 9.8%. The incidence of PAD among those who maintained NFG over 6 years was 4.7% and among those who progressed to diabetes over the 6 years, the

Discussion

This is one of the few longitudinal studies of PAD to be undertaken and one of the very few studies to look across categories of glucose metabolism [10]. This is an important study, as although PAD is a component of macrovascular disease, and is well known to occur more commonly among those with diabetes, few studies have observed the natural history of the disease [17]. In the present study the six-year incidence of PAD was 5.1% among those with NFG, 4.9% among those with IFG and 9.8% among

Acknowledgements

This work was supported by co-operative contracts between the Institut National de la Santé et de la Recherche Médicale (INSERM) and la Caisse Nationale de l’Assurance Maladies des Travailleurs Salariés (CNAMTS) (contract no. 3AM004) and Novartis Pharma (convention no. 98297), by INSERM Réseaux en Santé Publique (contract nos. 494003 and 4R001C) and by INSERM Interactions entre les determinants de la santé (contract no. 4D002D), by the Association Diabète Risque Vasculaire, the Fédération

References (32)

  • D. Walters et al.

    The prevalence, detection, and epidemiological correlates of peripheral vascular disease: a comparison of diabetic and non-diabetic subjects in an English community

    Diab Med

    (1992)
  • F.G.R. Fowkes et al.

    Edinburgh artery study: prevalence of asymptomatic and symptomatic peripheral arterial disease in the general population

    Int J Epidemiol

    (1991)
  • A.B. Newman et al.

    Ankle-arm index as a predictor of cardiovascular disease and mortality in the Cardiovascular Health Study. The Cardiovascular Health Study Group

    Arterioscler Thromb Vasc Biol

    (1999)
  • C.L. Leibson et al.

    Peripheral arterial disease, diabetes, and mortality

    Diabetes Care

    (2004)
  • The Global Lower Extremity Amputation Study Group: Epidemiology of lower extremity amputation in centres in Europe, North America and East, Asia

    Br J Surgery

    (2000)
  • A. MacGregor et al.

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

    Diabetes Care

    (1999)
  • Cited by (0)

    1

    The DESIR Study Group: INSERM U258: B. Balkau, P. Ducimetière, E. Eschwège; INSERM U367: F. Alhenc-Gelas; CHU D’ANGERS: Y. Gallois, A. Girault; Hôpital Bichat: F. Fumeron, M. Marre; Centres D’examens de Santé du Réseau 9: Alençon, Angers, Blois, Caen, Chartres, Chateauroux, Cholet, Le Mans, Orléans, Tours; Institut de Recherche en Médecine Générale: J. Cogneau; Medecins Géneralistes des Départements; Institut Inter Régional Pour la Santé: C. Born, E. Cacès, M. Cailleau, J.G. Moreau, F. Rakotozafy, J. Tichet, S. Vol.

    View full text