Diabetes and critical limb ischemia: The deadly duo in patients with symptomatic peripheral artery disease

Abstract

Inflammation plays an important role in the initiation and progression of peripheral artery disease (PAD). Patients with diabetes have an increased risk of developing PAD. Data regarding the prognostic implication of diabetes and inflammation in PAD patients are scarce. The aim of the study was to investigate the impact of diabetes and inflammation on all-cause mortality in patients with symptomatic PAD and preserved leftventricular ejection fraction (LVEF > 50%). The study was conducted at the Sestre milosrdnice University Hospital Center between January 2010 and January 2014 on 319 consecutive patients with symptomatic PAD and preserved LVEF (66.5% men, mean age 70±10 years, ankle brachial index 0.58±0.14). Thirty-eight (12%) patients died during median follow up period of 24 months (interquartile range, 16-34 months). On univariate analysis, C-reactive protein was significantly associated with all-cause mortality (HR 2.21, 95% CI 1.09-4.48). After multivariate regression analysis, age (HR 1.07, 95% CI 1.02-1.11), diabetes (HR 2.24, 95% CI 1.04-4.82), and critical limb ischemia (HR 2.22, 95% CI 1.03-4.80) remained the only independent predictors for all-cause mortality. Diabetes and critical limb ischemia are independently associated with an increased risk of mortality in symptomatic PAD patients with preserved LVEF.