There is a strong and well-established association between diabetes and coronary heart disease. However, the effect of diabetes on peripheral arterial beds is not much researched in patients without coronary heart disease. The authors wrote, “The impact of diabetes with comorbid risk factors on the outcome of peripheral vascular disease remains unexplored.”

The study involves the cross-sectional analysis of participants. The patients between 40 years to 90 years were screened for peripheral vascular disease. Peripheral vascular disease is defined as peripheral arterial disease (PAD ABI <0.9) and/or carotid artery stenosis (CAS, internal CAS ≥50%). Coronary Heart Disease (CHD) was defined as prior revascularization or myocardial infarction. The comorbid risk factors, along with diabetes include smoking, obesity, sedentary lifestyle, hypertension, family history of cardiovascular disease, and hyperlipidemia.

The study includes 3,517,804 participants. The peripheral arterial disease was found in 4.4% of the participants while 3.7% of participants were suffering from carotid artery stenosis. Among the participants, 376,528 people were suffering from diabetes. Out of these 324,680 people did not have coronary heart disease. There was a 4.3% increase in PAD with 1-2 comorbid risk factors, a 7.3% increase in PAD with 3-4 comorbid risk factors, and a 12% increase in 5 or more comorbid risk factors. Similar trends were observed in the prevalence of carotid artery disease (3.7%, 6.2%, 8.8%). After adjustment for sex, age, and race/ethnicity, an increasing odd of PAD and CAS was observed in those with diabetes and had 1-2, 3-4, and 5 or more risk factors as compared to those without diabetes. There was a twofold increase in PAD and CAS due to CHD in non-diabetic participants.

The study concluded that there is a risk of high odds in developing Peripheral arterial disease and carotid artery stenosis in patients with diabetes along with comorbid risk factors as compared to people without diabetes in patients without coronary artery disease. It is thus important that strategies should be in place for screening and preventing the PAD and CAS in patients with diabetes and risk factors.


Wilcox, T., Newman, J. D., Maldonado, T. S., Rockman, C., & Berger, J. S. (2018). Peripheral vascular disease risk in diabetic individuals without coronary heart disease. Atherosclerosis, 275, 419–425.