P3230The association of blood glucose and diabetes with peripheral arterial disease involving different vascular territories: results from 628 246 people who attended vascular screening

Abstract

Background: Diabetes mellitus is an important risk factor for atherosclerotic vascular disease. However it is unclear whether higher blood glucose concentrations within the normal reference range increase vascular risk in people without diabetes. In addition, previous studies have reported an inverse association between diabetes and abdominal aortic aneurysm, however the reasons for this are unclear. Purpose: To assess associations between blood glucose concentration, diabetes and arterial disease affecting different vascular territories (abdominal aortic aneurysm, carotid artery disease, lower extremity peripheral artery disease) in a large screened population. Methods: Between 2008 and 2013, 3.3 million self-referred individuals attended cardiovascular screening clinics (Life Line Screening) in the US and UK. Assessment included carotid duplex screening, abdominal aortic aneurysm screening, and ankle:brachial pressure (ABI) measurement. Major cardiovascular risk factors and medical history were recorded. Participants with incomplete data, missing blood samples, or prior cardiovascular disease were excluded, yielding 628 246 individuals in the current report. Results: The mean age at screening was 63±10 years, and 64% of attendees were women. The prevalence of screen-detected abdominal aortic aneurysm (≥30mm) was 0.5%, the prevalence of carotid artery stenosis (peak systolic velocity ≥110cm/s) was 3.5%, and the prevalence of lower extremity peripheral artery disease (ABI <0.9) was 2.6%. A prior diagnosis of diabetes was associated with an increased risk of carotid artery disease (OR 1.73 95% CI 1.68 - 1.78) and peripheral artery disease (OR 1.82 1.76 - 1.89), but with a lower risk of abdominal aortic aneurysm (OR 0.82 0.76 - 0.89). However, amongst attendees without known diabetes, there was a positive log-linear association between blood glucose levels and risk of all these types of vascular disease (Figure). Conclusion: Even across the normal reference range, higher blood glucose concentrations are associated with increased risk of vascular disease. The previously observed inverse association between diabetes mellitus and abdominal aortic aneurysm does not appear to be driven by higher blood glucose alone.