2222-PUB: Type 2 Diabetes as a Predictor of Cardiovascular Events in Peripheral Artery Disease vs. Coronary Artery Disease

Patients with established cardiovascular disease (CVD) are at a very high risk of cardiovascular events, and cardiovascular risk is considered extremely high in those with the combination of CVD and diabetes. However, the impact of type 2 diabetes (T2DM) on cardiovascular event risk may differ between different manifestations of CVD. To address this issue, we prospectively recorded cardiovascular events over 10 years in 1472 patients with angiographically proven stable coronary artery disease (CAD), of whom 454 had T2DM as well as in 465 patients with sonographically proven peripheral artery disease (PAD), of whom 204 had T2DM. Both among CAD and among PAD patients, those with T2DM were at a significantly higher risk of cardiovascular events than those who did not have diabetes (56.0% vs. 44.5%; p<0.001 and 68.5% vs. 50.6%; p<0.001, respectively). Cardiovascular risk was significantly higher in PAD than in CAD patients, both among those with T2DM (68.0% vs. 56.0%; p=0.003) and among those who did not have diabetes (50.6% vs. 44.5%; p=0.047). In multivariate analyses, T2DM (HR 1.48 [1.13-1.70); p<0.001) and presence of PAD versus that of CAD (HR 1.93 [1.64-2.28];p<0.001) were mutually independent predictors of cardiovascular events. An interaction term T2DM by PAD vs. CAD was non-significant (p=0.146), indicating that the relative risk increase conferred by T2DM did not differ significantly between PAD and CAD patients. We conclude that T2DM increases cardiovascular event risk among patients with PAD as well as among those with CAD and that PAD confers a higher risk of cardiovascular events than stable CAD irrespective of the presence of T2DM.