Risk Factors for and Risk of Peripheral Artery Disease in Swedish Persons with Type 2 Diabetes Mellitus: a Nationwide, Register-Based Study

Objective: To investigate to what extent having control of peripheral artery disease (PAD) risk factors associates with the risk of incident PAD in persons with type 2 diabetes. Research Design and Methods: 148 096 persons with type 2 diabetes in the Swedish National Diabetes Register between 2005 and 2009 were included, and matched with 320 066 controls on the basis of age, sex and county. Few controls who developed type 2 diabetes after recruitment, during wash-in (<0.2%), were not censored, but were instead matched with two new controls. Persons with type 2 diabetes were evaluated according to the number of PAD risk factors beyond recommended guide-line levels at baseline, including low-density lipoprotein cholesterol, blood pressure, smoking, glycated hemoglobin, and estimated glomerular filtration rate. Incident PAD events were ascertained from 2006 to 2019. Results: A graded association was observed between the number of PAD risk factors not at target and incident PAD in persons with type 2 diabetes. The adjusted hazard ratio for PAD was 1.41 (95% confidence interval [CI], 1.23–1.63) for type 2 diabetes with all PAD risk factors within target compared with controls matched for sex, age and county but not risk factor status, contrasted with 9.28 (95% CI, 3.62-23.79) for all 5 PAD risk factors not at target. CONCLUSIONS: A graded association was observed between increasing number of PAD risk factors not at target and incident PAD in patients with type 2 diabetes.