Observational Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Jun 15, 2021; 12(6): 883-892
Published online Jun 15, 2021. doi: 10.4239/wjd.v12.i6.883
Control of modifiable risk factors and major adverse cardiovascular events in people with peripheral artery disease and diabetes
Jonathan Golledge, Aaron Drovandi, Sophie Rowbotham, Ramesh Velu, Frank Quigley, Jason Jenkins
Jonathan Golledge, Aaron Drovandi, Sophie Rowbotham, Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville 4811, Queensland, Australia
Jonathan Golledge, Ramesh Velu, Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville 4811, Queensland, Australia
Frank Quigley, Department of Vascular Surgery, Mater Hospital, Townsville 4811, Queensland, Australia
Jason Jenkins, Department of Vascular Surgery, The Royal Brisbane and Women's Hospital, Brisbane 4000, Queensland, Australia
Author contributions: Golledge J was the guarantor; Golledge J, Rowbotham S, Quigley F, Velu R, and Jenkins J designed the study; Golledge J, Rowbotham S, Quigley F, Velu R, and Jenkins J participated in data collection; Golledge J and Drovandi A analysed and interpreted the data, and drafted the initial manuscript; All authors reviewed and approved the final manuscript version.
Supported by The National Health and Medical Research Council, No. 1063476 and No. 1022752; James Cook University and Queensland Government supported this work. JG holds a Practitioner Fellowships from the National Health and Medical Research Council, No. 1117061.
Institutional review board statement: The study was performed in accordance with the Helsinki declaration and ethical approval was granted from the James Cook University and Townsville Hospital Health Service human research ethics committees (HREC/13/QTHS/125 and HREC/14/QTHS/203).
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Data sharing statement: The main data from this study was presented in the manuscript. Individual participant data cannot be provided due to regulations inherent in a legal agreement required as a result of the governance approval covering the data and ethics of the project. Data are available from the corresponding author upon reasonable request.
STROBE statement: The authors have read the STROBE Statement, and the manuscript was prepared and revised according to the STROBE Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jonathan Golledge, MChir, Director, Professor, Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, 100 Angus Smith Drive, Townsville 4811, Queensland, Australia. jonathan.golledge@jcu.edu.au
Received: January 19, 2021
Peer-review started: January 19, 2021
First decision: February 25, 2021
Revised: March 8, 2021
Accepted: May 20, 2021
Article in press: May 20, 2021
Published online: June 15, 2021
ARTICLE HIGHLIGHTS
Research background

Peripheral artery disease is collection of chronic occlusive and aneurysmal diseases associated with a high incidence of major adverse cardiovascular events (MACE).

Research motivation

In this study, the control of modifiable risk factors for MACE was assessed through the development and testing of a new score called peripheral artery disease (PAD)-medical.

Research objectives

The aim of this study was to assess how the PAD-medical score, which assessed the control of modifiable risk factors was associated with the risk of MACE in people with a diagnosis of both peripheral artery disease and diabetes.

Research methods

Patients with previously diagnosed peripheral artery disease and diabetes were recruited from three hospitals in Queensland Australia. PAD-medical score was calculated as a result from zero (worst management) to five (best management) based on the control of modifiable risk factors and implementation of medical management. Cox proportional hazard analyses assessed the association of PAD-medical score (one unit increase) with MACE adjusted for age, sex, smoking, IHD and prior stroke.

Research results

Of 424 participants recruited less than 10% had optimal control of modifiable risk factors evidenced by a top PAD-medical score. A one-unit increase in PAD-medical was associated with a significantly lower risk of MACE after adjusting for other risk factors (HR = 0.79, 95%CI: 0.63-0.98). Of the five different components of PAD-medical, only smoking abstinence was independently associated with a reduced risk of MACE (HR = 0.61, 95%CI: 0.38-0.97).

Research conclusions

The PAD-medical score represents an easy to use tool for the quantification of the control of modifiable risk factors for MACE in patients with peripheral artery disease and diabetes.

Research perspectives

Further research into this field requires a larger participant cohort from a more diverse population to investigate the wider applicability of the PAD-medical score.