Impact of peripheral artery disease (PAD) on risk of major adverse cardiovascular events (MACE) in patients with type 2 diabetes.

Background: As of 2021, global estimates show that 536.6 million adults aged 20 to 79 years are living with type 2 diabetes (T2D), and the prevalence of T2D is projected to increase to about 783 million individuals by 2045. Peripheral artery disease (PAD), which is caused by atherosclerosis of the extremities (most commonly lower limbs) leading to the narrowing of blood vessels, is a major risk factor for lower extremity amputation and is a common comorbidity of diabetes. Patients with both T2D and PAD often have advanced systemic vascular disease, which may involve other vascular territories, such as the coronary and cerebral arteries. However, PAD is underdiagnosed and underrecognized, particularly at earlier stages of the disease. Methods: This retrospective cohort study used real-world data to characterize the vascular risk profile of patients with T2D with PAD and those with T2D without other evidence of atherosclerotic cardiovascular disease, including irreversible harm events of the heart, limbs, and brain. Results: Patients with T2D and PAD had a higher risk of major adverse cardiovascular events (MACE) and major adverse limb events (MALE) compared with those without PAD. Ankle-brachial index and duplex ultrasound were the most commonly used assessments during diagnostic evaluation for PAD. Conclusions: Among patients with T2D, presence of PAD was associated with an increased risk of all evaluated outcomes. These findings highlight the significant vascular burden of PAD among patients with T2D.