Single and Combined Effects of Peripheral Artery Disease and of Type 2 Diabetes Mellitus on the Risk of Cardiovascular Events in Women

Both peripheral artery disease (PAD) and type 2 diabetes (T2DM) are associated with a high risk of cardiovascular events. However, the single and combined effects of PAD and of T2DM in women have not been investigated yet and are addressed in the present study. We prospectively recorded cardiovascular events in a series of 436 women of whom 94 had PAD and 342 did not have PAD. At baseline, the prevalence of diabetes was higher in women with PAD than in those who did have PAD (41.5 vs. 21.6%, p<0.001). Over a mean follow-up period of 7.2 years we recorded 1cardiovascular events. When compared to the event rate in women with neither PAD nor T2DM (14.9%) the event rate was not significantly increased in those with T2DM but without PAD (16.2%; p=0.972) but was significantly higher in nondiabetic women with PAD (47.3%; p<0.001) and further increased in those with both PAD and T2DM (76.9%; p<0.001). Nondiabetic women with PAD were at a significantly higher cardiovascular risk than women with T2DM who did not have PAD (p=0.001). When compared to women with neither PAD nor T2DM, adjusted hazard ratios were 0.93 [0.48-1.80]; p=0.831, 3.80 [2.02-7.13]; p<0.001, and 7.41 [3.87-14.19]; p<0.001 for women with T2DM only, for those with PAD only and for those with the combination of PAD plus T2DM, respectively. We conclude that T2DM strongly increases the risk of future cardiovascular events in women with PAD. However, type 2 diabetic women who do not have PAD are at a significantly lower cardiovascular event risk than nondiabetic women with PAD. PAD in women is a stronger risk factor than T2DM.