Comprehensive risk factor control in type 2 diabetes and incident peripheral artery disease

Abstract Aims Patients with type 2 diabetes (T2D) are at an elevated risk of peripheral artery disease (PAD) compared to the general population. This study aimed to investigate whether joint risk factor control could mitigate the T2D-related excess risk of PAD. Methods This study included 14,458 participants with T2D who were initially free of cardiovascular disease and PAD and matched them with 56,961 control individuals from the UK Biobank cohort. Participants with T2D were categorized according to the number of risk factors controlled, including no current smoking, being physically active, healthy diet, and guideline-recommended levels of glycated hemoglobin, body mass index, blood pressure, low-density lipoprotein cholesterol, and urinary albumin. Results During a median follow-up of 11.9 years, 408 (2.8%) participants with T2D and 671 (1.2%) matched non-T2D individuals developed PAD. Among participants with T2D, a greater number of controlled risk factors was associated with lower PAD incidence (∼23% lower risk per additional factor). Compared to the matched non-T2D individuals, the hazard ratio (95% CI) for PAD among participants with T2D gradually decreased from 2.49 (1.94, 3.19) for those with ≤2 risk factors controlled to 0.82 (0.51, 1.31) for those with ≥6 risk factors controlled. At age 45 years, the difference in PAD-free survival time was on average -1.41 (95% CI -1.78, -1.03) years for participants with T2D who had ≤2 risk factors controlled and -0.11 (95% CI -0.38, 0.16) years for those who had ≥6 risk factors controlled compared to the non-T2D individuals. Conclusion Individuals with T2D who achieved optimal risk factor control had no excess risk of PAD than matched non-T2D counterparts. Efforts to promote comprehensive risk factor management in T2D are imperative for reducing the burden of PAD.