442-P: Diabetic Foot Ulcer Amputation Is Associated with Two-Fold Increased Risk of Incident Cardiovascular Disease—A Korean National Health Information Database Study

Diabetic Foot Ulcer (DFU), a critical complication of diabetes, impacts about 8% of individuals with diabetes and leads to a 20% risk of lower extremity amputation. People with DFU amputation are widely recognized to have an increased risk of cardiovascular disease (CVD) and mortality. However, previous studies have been limited by their small scale and cross-sectional design. The aim of this study was to quantify the risk of CVD and related mortality following DFU amputation, utilizing a large-scale prospective database.We included over 1.2 million individuals with diabetes who participated in nationwide health checkups from 2009 to 2012, with clams data linked through the Korean National Health Insurance Service. Incident CVD was defined as myocardial infarction (MI), stroke and cardiovascular mortality that occurred at least one year after a DFU amputation. Cox proportional hazard model was used to assess the risk of CVD in people with DFU amputation compared to those with diabetes but not amputated. Among 1,229,689 individuals with diabetes, 1,487 (0.12%) had a DFU amputation at baseline. Individuals with DFU tended to be older, predominantly male, and more often belong to the lower income 10%. During a median follow-up of 7.2 years (interquartile range 3.08), people with DFU amputation had a significantly higher incidence rate of CVD compared to those without DFU amputation (32.6 vs 11.0 per 1,000 person-years) with a hazard ratio (HR) of 1.8 (95% CI 1.6-2.1). Specifically, the HRs for MI and stroke were 2.2 (95% CI 1.9-2.6) and 1.6 (95% CI 1.4-1.8). Furthermore, CVD mortality significantly increased in people with DFU amputation compared to those without, with an HR of 2.11. (95% CI 1.9-2.3).Using a comprehensive nationwide health information database, we found that individuals with DFU amputation had up to a two-fold higher risk of CVD and associated mortality compared to those with diabetes but without DFU.