Abstract
Background
Recent data on trends in diabetes mellitus (DM) prevalence and long‐term effect on mortality in peripheral arterial disease (PAD) subjects is lacking.
Methods
All subjects discharged from any VA medical center between October 1990 to September 1997 with an International Classification of Diseases (ICD)‐9 code for PAD and DM in the discharge summary were retrospectively identified. Demographic data were extracted from the database. Mortality data were obtained from the Beneficiary Information and Resource Locator. Outcome measures were age specific DM prevalence over time, and short‐term and long‐term mortality.
Results
Of 33, 629 patients with PAD, 9474 (29%) had DM. Diabetes mellitus subjects were less likely to be white and had more comorbidities. Mean length of hospital stay was greater for DM (22.3 d vs 18.7 days, P < 0.001). Mortality was higher for DM at 180 days (9.8% vs 8.4%, P < 0.001), 1 year (16.4% vs 13.7%, P < 0.001), and continues to increase at 8 years of follow‐up. Logistic regression analysis showed no interaction between DM and coronary artery disease (CAD).
Conclusions
Diabetes mellitus increases all‐cause mortality in subjects with PAD starting at 6 months post‐discharge and continues to be higher even at 8 years of follow‐up. There was a lack of interaction of DM and CAD on mortality in this cohort of subjects with PAD. Copyright © 2009 Wiley Periodicals, Inc.
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References
- 1. Marso SP, Hiatt WR. Peripheral arterial disease in patients with diabetes. J Am Coll Cardiol 2006; 47: 921–929. [DOI] [PubMed] [Google Scholar]
- 2. Peripheral arterial disease in people with diabetes. Diabetes Care 2003; 26: 3333–3341. [DOI] [PubMed] [Google Scholar]
- 3. Kamalesh M, Feigenbaum H, Sawada S. Challenge of identifying patients with diabetes who are at low risk for coronary events by use of cardiac stress imaging. Am Heart J 2004; 147: 561–563. [DOI] [PubMed] [Google Scholar]
- 4. Miller TD, Redberg RF, Wackers FJ. Screening asymptomatic diabetic patients for coronary artery disease: why not? J Am Coll Cardiol. 2006; 48: 761–764. [DOI] [PubMed] [Google Scholar]
- 5. Kamalesh M, Feigenbaum H, Sawada S. Assessing prognosis in patients with diabetes mellitus: The Achilles' heel of stress imaging studies? Am J Card 2007; 99: 1016–1019. [DOI] [PubMed] [Google Scholar]
- 6. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP)Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001; 285: 2486–2497. [DOI] [PubMed] [Google Scholar]
- 7. Golomb BA, Dang TT, Criqui MH. Peripheral arterial disease. Morbidity and mortality implications. Circulation 2006; 114: 688–699. [DOI] [PubMed] [Google Scholar]
- 8. Pladevall M, Goff DC, Nichaman MZ, Ramsey D, Ortiz C, Labarthe DR. An assessment of the validity of ICD code 410 to identify hospital admissions for myocardial infarction: the Corpus Christi Heart Project. Int J Epidemiol 1996; 25: 948–952. [DOI] [PubMed] [Google Scholar]
- 9. Petersen LA, Normand ST, Daley J, McNeil BJ. Outcome of myocardial infarction in veterans health administration patients as compared with Medicare patients. N Engl J Med 2000; 343: 1934–1941. [DOI] [PubMed] [Google Scholar]
- 10. Wright SM, Petersen LA, Lamkin RP, Daley J. Increasing use of Medicare services by veterans with acute myocardial infarction. Med Care 1999; 37: 529–537. [DOI] [PubMed] [Google Scholar]
- 11. Fisher SG, Weber L, Goldberg J, Davis F. Mortality ascertainment in veteran population: Alternatives to the National Death Index. Am J Epidemiol 1995; 141: 242–250. [DOI] [PubMed] [Google Scholar]
- 12. Fleming C, Fisher ES, Chang CH, Bubolz TA, Malenka DJ. Studying outcomes and hospital utilization in the elderly: The advantages of a merged database for Medicare and veterans affairs hospitals. Med Care 1992; 30: 377–391. [DOI] [PubMed] [Google Scholar]
- 13. Rutter MK, Nesto RW. The changing costs and benefits of screening for asymptomatic coronary heart disease in patients with diabetes. Nat Clin Pract Endocrinol Metab 2007; 3: 26–35. [DOI] [PubMed] [Google Scholar]
- 14. Haffner SM, Lehto S, Ronnemaa T, Pyorala K, Laakso M. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med 1998; 339(4): 229–234. [DOI] [PubMed] [Google Scholar]
- 15. Wackers FJ, Young LH, Inzucchi SE; Detection of Ischemia in Asymptomatic Diabetics Investigators. Detection of silent myocardial ischemia in asymptomatic diabetic subjects: the DIAD study. Diabetes Care 2004; 27: 1954–1961. [DOI] [PubMed] [Google Scholar]
- 16. Creager MA, Jones DW, Easton JD; American Heart Association. Atherosclerotic Vascular Disease Conference: Writing Group V: medical decision making and therapy. Circulation 2004; 109: 2634–2642. [DOI] [PubMed] [Google Scholar]
- 17. Beckman JA, Jaff MR, Creager MA. The United States preventive services task force recommendation statement on screening for peripheral arterial disease: more harm than benefit? Circulation 2006; 114: 861–866. [DOI] [PubMed] [Google Scholar]
- 18. Saw J, Bhatt DL, Moliterno DJ. The influence of peripheral arterial disease on outcomes: a pooled analysis of mortality in eight large randomized percutaneous coronary intervention trials. J Am Coll Cardiol 2006; 48: 1567–1572. [DOI] [PubMed] [Google Scholar]
- 19. Tierney WM, McDonald CJ. Practice databases and their uses in clinical research. Stat Med 119; 10: 541–547. [DOI] [PubMed] [Google Scholar]