Summary
We investigated the cross-sectional association between peripheral arterial disease and glycaemic level in an age, sex, and glucose tolerance stratified random sample from a 50–74-year-old Caucasian population. Subjects treated with oral hypoglycaemic agents or insulin were classified as having known diabetes mellitus (KDM) (n=67). Using two oral glucose tolerance tests, and based on World Health Organisation criteria, all other participants were categorized as having a normal (NGT) (n=288), an impaired (IGT) (n=170), or a diabetic (NDM) (n=106) glucose tolerance. Prevalence rates of ankle-brachial pressure index less than 0.90 were 7.0%, 9.5%, 15.1% and 20.9% in NGT, IGT, NDM and KDM subjects, respectively (chi-square test for linear trend:p<0.01). Prevalence rates ofany peripheral arterial disease (ankle-brachial pressure index <0.90, at least one monophasic or absent Doppler flow curve or vascular surgery) were 18.1%, 22.4%, 29.2% and 41.8% in these categories (chi-square test for linear trend:p<0.0001). The prevalence ofany peripheral arterial disease was higher in KDM and NDM than in NGT (p<0.03,p<0.0001, respectively), whereas no statistically significant difference was demonstrated between IGT and NGT. The same applied when using the anklebrachial pressure index criterion. Logistic regression analyses showed thatany arterial disease was significantly associated with HbA1c, fasting and 2-h postload plasma glucose after correction for cardiovascular risk factors (odds ratios and 95% confidence intervals 1.35; 1.10–1.65 per %, 1.20; 1.06–1.36 and 1.06; 1.01–1.12 per mmol/l, respectively), whereas it was not associated with fasting and 2-h post-load specific insulin. Ankle-brachial pressure indices were not associated with either plasma glucose parameters or insulin in univariate or multivariate analyses. In conclusion, parameters of glucose tolerance are independently associated withany peripheral arterial disease, whereas insulin is not. [Diabetologia (1995) 38: 86–96]
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
Abbreviations
- NGT:
-
Normal glucose tolerance
- IGT:
-
impaired glucose tolerance
- NDM:
-
newly-diagnosed diabetes mellitus
- KDM:
-
known diabetes mellitus (=using hypoglycaemic medication)
- PAD:
-
peripheral arterial disease
- ABPI:
-
(systolic) ankle-brachial pressure index
- OR:
-
odds ratio; 95% CI, 95% confidence interval
- WHR:
-
waist/hip ratio
References
Pyörälä K, Laakso M, Uusitupa M (1987) Diabetes and atherosclerosis: an epidemiologic view. Diabet Metab Rev 3:463–524
Donahue RP, Orchard TJ (1992) Diabetes mellitus and macrovascular complications. An epidemiological perspective. Diabetes Care 15:1141–1155
Vogt MT, Wolfson SK, Kuller LH (1992) Lower extremity arterial disease and the aging process: a review. J Clin Epidemiol 5:529–542
McKenna M, Wolfson S, Kuller L (1991) The ratio of ankle and arm arterial pressure as an independent predictor of mortality. Atherosclerosis 87:119–128
Criqui MH, Langer RD, Fronek A et al. (1992) Mortality over a period of 10 years in patients with peripheral arterial disease. N Engl J Med 326:381–386
Vogt MT, Wolfson SK, Kuller LH (1993) Segmental arterial disease in the lower extremities: correlates of disease and relationship to mortality. J Clin Epidemiol 46:1267–1276
Ögren M, Hedblad B, Isacsson SO, Janzon L, Jungquist G, Lindell SE (1993) Non-invasively detected carotid stenosis and ischaemic heart disease in men with leg arteriosclerosis. Lancet 342:1138–1141
Schroll M, Munk O (1981) Estimation of peripheral arteriosclerotic disease by ankle blood pressure measurements in a population study of 60-year-old men and women. J Chron Dis 34:261–269
Criqui MH, Fronek A, Barrett-Connor E, Klauber MR, Gabriel S, Goodman D (1985) The prevalence of peripheral arterial disease in a defined population. Circulation 71:510–515
Gofin R, Kark JD, Friedlander Y et al. (1987) Peripheral vascular disease in a middle-aged population sample. The Jerusalem lipid research clinic prevalence study. Isr J Med Sci 23:157–167
Fowkes FGR, Housley E, Cawood EHH, Macintyre CCA, Ruckley CV, Prescott RJ (1991) Edinburgh artery study: prevalence of asymptomatic and symptomatic peripheral arterial disease in the general population. Int J Epidemiol 20:384–392
Beach KW, Brunzell JD, Conquest LL, Strandness DE (1979) The correlation of arteriosclerosis obliterans with lipoproteins in insulin-dependent and non-insulin-dependent diabetes. Diabetes 28:836–840
Beach KW, Strandness DE (1980) Arteriosclerosis obliterans and associated risk factors in insulin-dependent and non-insulin-dependent diabetes. Diabetes 29:882–888
Beach KW, Bedford GR, Bergelin RO et al. (1988) Progression of lower-extremity arterial occlusive disease in type II diabetes mellitus. Diabetes Care 11:464–472
Walters DP, Gatling W, Mullee MA, Hill RD (1992) The prevalence, detection, and epidemiological correlates of peripheral vascular disease: a comparison of diabetic and non-diabetic subjects in an English community. Diabet Med 9:710–715
Vaccaro O, Pauciullo P, Rubba P et al. (1985) Peripheral arterial circulation in individuals with impaired glucose tolerance. Diabetes Care 8:594–597
Fujimoto WY, Leonetti DL, Kinyoun JL, Shuman WP, Stolov WC, Wahl PW (1987) Prevalence of complications among second-generation Japanese-American men with diabetes, impaired glucose tolerance, or normal glucose tolerance. Diabetes 36:730–739
Jackson CA, Yudkin JS, Forrest RD (1992) A comparison of the relationships of the glucose tolerance test and the glycated haemoglobin assay with diabetic vascular disease in the community. The Islington Diabetes Survey. Diabetes Res Clin Pract 17:111–123
Mooy JM, Grootenhuis PA, De Vries H, Heine RJ, Bouter LM (1992) The Hoorn Study: disorders of glucose tolerance in a general Caucasian population. Neth J of Internal Med 41:A29 (Abstract)
Baker AR, Macpherson DS, Evans DH, Bell PRF (1987) Pressure studies in arterial surgery. Eur J Vasc Surg 1:273–283
Everhardt JE, Pettitt DJ, Knowler WC, Rose FA, Bennett PH (1988) Medial arterial calcification and its association with mortality and complications of diabetes. Diabetologia 31:16–23
Neubauer B (1971) A quantitative study of peripheral arterial calcification and glucose tolerance in elderly diabetics and non-diabetics. Diabetologia 7:409–413
Young MJ, Adams JE, Anderson GF, Boulton AJM, Cavanagh PR (1993) Medial arterial calcification in the feet of diabetic patients and matched non-diabetic control subjects. Diabetologia 36:615–621
Edmonds ME, Roberts VC, Watkins PJ (1982) Blood flow in the diabetic neuropathic foot. Diabetologia 22:9–15
Goebel FD, Füessl HS (1983) Mönckeberg's sclerosis after sympathetic denervation in diabetic and non-diabetic subjects. Diabetologia 24:347–350
Kempczinski RF (1985) The role of non-invasive testing in the evaluation of lower extremity arterial insufficiency. In: Kempczinski RF (ed) The ischaemic leg. Yearbook medical Publ. Inc., Chicago pp 125–144
Fronek A, Johansen K, Dilley R, Bernstein E (1973) Noninvasive physiologic tests in the diagnosis and characterization of peripheral arterial occlusive disease. Am J Surg 126:205–213
Marinelli MR, Beach KW, Glass MJ, Primozich JF, Strandness DE (1979) Non-invasive test vs clinical evaluation of arterial disease. JAMA 241:2031–2043
World Health Organization Study Group on Diabetes Mellitus (1985) Technical report series No 727, WHO, Geneva
Brennan P, Silman A (1992) Statistical methods for assessing observer variability in clinical measures. BMJ 304:1491–1494
Friedewald WT, Levy RI, Fredrickson DS (1972) Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem 18:499–502
Rose GA, Blackburn H (1968) Cardiovascular survey methods. WHO Monograph Series No 56 WHO, Geneva
Kromhout D, Dalderup LM (1991) Thirty years Zutphen Study. Its past, present and future. In: Kromhout D (ed) Coronary heart disease risk, diet and aging, RIVM, Bilthoven
Al Sayegh H, Jarrett RJ (1979) Oral glucose tolerance tests and the diagnosis of diabetes: results of a prospective study based on the Whitehall Survey. Lancet II:431–433
Rushforth NB, Miller M, Bennett PH (1979) Fasting and two-hour post-load glucose levels for the diagnosis of diabetes. The relationship between glucose levels and complications of diabetes in the Pima Indians. Diabetologia 16:373–379
Da Silva A, Widmer LK, Ziegler HW, Nissen C, Schweizer W (1979) The Basle Longitudinal Study: report on the relation of initial glucose level to baseline ECG abnormalities, peripheral artery disease and subsequent mortality. J Chron Dis 32:797–803
Beach KW, Brunzell JD, Strandness DE (1982) Prevalence of severe arteriosclerosis obliterans in patients with diabetes mellitus. Relation to smoking and form of therapy. Atherosclerosis 2:275–280
Criqui MH, Browner D, Fronek A et al. (1989) Peripheral arterial disease in large vessels is epidemiologically distinct from small vessel disease. Am J Epidemiol 129:1110–1119
Fowkes FGR, Housley E, Riemersma RA et al. (1992) Smoking, lipids, glucose intolerance, and blood pressure as risk factors for peripheral atherosclerosis compared with ischemic heart disease in the Edinburgh Artery Study. Am J Epidemiol 135:331–340
Orchard TJ, Strandness DE (1993) Assessment of peripheral vascular disease in diabetes. Report and recommendations of an international workshop sponsored by the American Heart Association and the American Diabetes Association 18–20 September 1992, New Orleans, Louisiana. Diabetes Care 16:1199–1209
Pyörälä K, Savolainen E, Kaukola S, Haapakoski J (1985) Plasma insulin as coronary heart disease risk factor: relationship to other risk factors and predictive value during 9/12 year follow-up of the Helsinki Policemen Study population. Acta Med Scand [Suppl] 701:38–52
Fontbonne A, Tchobroutsky G, Eschwege E, Richards JL, Claude JR, Rosselin GE (1988) Coronary heart disease mortality risk: plasma insulin level is a more sensitive marker than hypertension or abnormal glucose tolerance in overweight males: the Paris prospective study. Int J Obesity 12:557–565
Mykkänen L, Laakso M, Pyörälä K (1993) High plasma insulin level associated with coronary artery disease in the elderly. Am J Epidemiol 137:1190–1202
Standl E, Janka HU (1985) High serum insulin concentrations in relation to other cardiovascular risk factors in macrovascular disease of type 2 diabetes. Hormone Met Res 17:46–51
Uusitupa MIJ, Niskanen LK, Siitonen O, Voutilainen E, Pyörälä K (1990) 5-year incidence of atherosclerotic vascular disease in relation to general risk factors, insulin level, abnormalities in lipoprotein composition in non-insulin-dependent diabetic and non-diabetic subjects. Circulation 82:27–36
Vogt MT, Cauley JA, Kuller LH, Hulley SB (1993) Prevalence and correlates of lower extremity arterial disease in elderly women. Am J Epidemiol 137:559–568
Ouriel K, McDonnell AE, Metz CE, Zarins CK (1982) A critical evaluation of stress testing in the diagnosis of peripheral vascular disease. Surgery 91:686–693
Bernstein EF, Fronek A (1982) Current status of non-invasive tests in the diagnosis of peripheral arterial disease disease. Surg Clin North Am 62:473–487
Strandness DE, Priest RE, Gibbons GE (1964) Combined clinical and pathologic study of diabetic and non-diabetic peripheral arterial disease. Diabetes 13:366–372
Janka HU, Standl E, Mehnert H (1980) Peripheral vascular disease in diabetes mellitus and its relation to cardiovacular risk factors: screening with the Doppler ultrasonic technique. Diabetes Care 3:207–213
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Beks, P.J., Mackaay, A.J.C., de Neeling, J.N.D. et al. Peripheral arterial disease in relation to glycaemic level in an elderly Caucasian population: the Hoorn Study. Diabetologia 38, 86–96 (1995). https://doi.org/10.1007/BF02369357
Received:
Revised:
Issue Date:
DOI: https://doi.org/10.1007/BF02369357