Hemoglobin A1c levels predict risk of peripheral arterial disease

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In adult patients with diabetes, increased hemoglobin A1c (HbA1c) levels are associated with an elevated risk of peripheral arterial disease, according to a report in the April issue of Diabetes Care.

"This study is one of the first prospective studies to examine the association of HbA1c and the development of peripheral arterial disease (PAD) in diabetics looking specifically at different manifestations of PAD," Dr. Elizabeth Selvin from Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland told Reuters Health.

Dr. Selvin and colleagues used data from The Atherosclerosis Risk in Communities study to investigate whether HbA1c is related to PAD in 1,894 middle-aged adults with diabetes.

The risk of hospitalization related to PAD increased with increasing tertiles of HbA1c level, the authors report, as did the risk of intermittent claudication.

Specifically, patients in the second and third tertiles of HbA1c level were 53% and 64% more likely, respectively, than those with the lowest HbA1c to have PAD, as defined solely on the basis of a low ankle-brachial index (ABI below 0.9), the results indicate.

The researchers note that trends toward higher risk of PAD with higher HbA1c level were evident for all manifestations of PAD, regardless of whether or not diabetes had been diagnosed.

Fasting blood glucose levels were also associated with the risk of PAD, the report indicates, but the association was much weaker than that observed for HbA1c level.

"Our results suggest that poor glycemic control, as indicated by elevated HbA1c levels in individuals with diabetes, is associated with an increased risk of PAD independently of other known risk factors," Dr. Selvin concluded. "This association was particularly strong for the symptomatic, more severe manifestations of PAD, including intermittent claudication and PAD-related hospitalizations."

"Ultimately, our results suggest that efforts to improve glycemic control in persons with diabetes may substantially reduce the risk of PAD development," Dr. Selvin added.