Observational Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Jun 15, 2021; 12(6): 883-892
Published online Jun 15, 2021. doi: 10.4239/wjd.v12.i6.883
Control of modifiable risk factors and major adverse cardiovascular events in people with peripheral artery disease and diabetes
Jonathan Golledge, Aaron Drovandi, Sophie Rowbotham, Ramesh Velu, Frank Quigley, Jason Jenkins
Jonathan Golledge, Aaron Drovandi, Sophie Rowbotham, Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville 4811, Queensland, Australia
Jonathan Golledge, Ramesh Velu, Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville 4811, Queensland, Australia
Frank Quigley, Department of Vascular Surgery, Mater Hospital, Townsville 4811, Queensland, Australia
Jason Jenkins, Department of Vascular Surgery, The Royal Brisbane and Women's Hospital, Brisbane 4000, Queensland, Australia
Author contributions: Golledge J was the guarantor; Golledge J, Rowbotham S, Quigley F, Velu R, and Jenkins J designed the study; Golledge J, Rowbotham S, Quigley F, Velu R, and Jenkins J participated in data collection; Golledge J and Drovandi A analysed and interpreted the data, and drafted the initial manuscript; All authors reviewed and approved the final manuscript version.
Supported by The National Health and Medical Research Council, No. 1063476 and No. 1022752; James Cook University and Queensland Government supported this work. JG holds a Practitioner Fellowships from the National Health and Medical Research Council, No. 1117061.
Institutional review board statement: The study was performed in accordance with the Helsinki declaration and ethical approval was granted from the James Cook University and Townsville Hospital Health Service human research ethics committees (HREC/13/QTHS/125 and HREC/14/QTHS/203).
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Data sharing statement: The main data from this study was presented in the manuscript. Individual participant data cannot be provided due to regulations inherent in a legal agreement required as a result of the governance approval covering the data and ethics of the project. Data are available from the corresponding author upon reasonable request.
STROBE statement: The authors have read the STROBE Statement, and the manuscript was prepared and revised according to the STROBE Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jonathan Golledge, MChir, Director, Professor, Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, 100 Angus Smith Drive, Townsville 4811, Queensland, Australia. jonathan.golledge@jcu.edu.au
Received: January 19, 2021
Peer-review started: January 19, 2021
First decision: February 25, 2021
Revised: March 8, 2021
Accepted: May 20, 2021
Article in press: May 20, 2021
Published online: June 15, 2021
Processing time: 136 Days and 13.2 Hours
Abstract
BACKGROUND

People with diabetes and peripheral artery disease (PAD) have a high risk of major adverse cardiovascular events (MACE). Prior research suggests that medical therapies aimed to control modifiable risk factors are poorly implemented in patients with PAD.

AIM

To examine the association between the control of modifiable risk factors, estimated by the novel PAD-medical score, and the incidence of MACE in people with PAD and diabetes.

METHODS

Participants were recruited from out-patient clinics if they had a diagnosis of both PAD and diabetes. Control of reversible risk factors was assessed by a new composite measure, the PAD-medical score. This score takes into account the control of low-density lipoprotein cholesterol, blood pressure, blood glucose, smoking and prescription of an anti-platelet. Participants were followed to record incidence of myocardial infarction, stroke and cardiovascular death (MACE). The association of PAD-medical score with MACE was assessed using Cox proportional hazard analyses adjusting for age, sex and prior history of ischemic heart disease and stroke.

RESULTS

Between 2002 and 2020, a total of 424 participants with carotid artery disease (n = 63), aortic or peripheral aneurysm (n = 121) or lower limb ischemia (n = 240) were prospectively recruited, and followed for a median duration (inter-quartile range) of 2.0 (0.2–4.4) years. Only 33 (7.8%) participants had the optimal PAD-medical score of five, with 318 (75%) scoring at least three out of five. There were 89 (21.0%) participants that had at least one MACE during the follow-up period. A one-unit higher PAD-medical score was associated with lower risk of MACE (HR = 0.79, 95%CI: 0.63-0.98) after adjusting for other risk factors.

CONCLUSION

The PAD-medical score provides a simple way to assess the control of modifiable risk factors targeted by medical management aimed to reduce the incidence of MACE.

Keywords: Peripheral artery disease; Diabetes; Major cardiovascular events; Medical management; Prospective study; Clinical practice

Core Tip: The control of modifiable risk factors for major adverse cardiovascular events (MACE) is frequently poorly achieved in patients with peripheral artery disease (PAD). The PAD-medical score is an easy way to assess the control of modifiable risk factors. In the current study only 33 (7.8%) of the included participants had optimal control of risk factors evidenced by a maximum PAD-medical score. Adjusted analyses found that a one-unit higher PAD-medical score was associated with a significantly lower risk of MACE (HR = 0.79, 95%CI: 0.63-0.98).