Risk Factors for and Risk of Peripheral Artery Disease in Swedish Individuals With Type 2 Diabetes: A Nationwide Register-Based Study

OBJECTIVE To investigate to what extent having control of peripheral artery disease (PAD) risk factors is associated with the risk of incident PAD in individuals with type 2 diabetes. RESEARCH DESIGN AND METHODS A total of 148,096 individuals 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. A few controls who developed type 2 diabetes after recruitment, during wash-in (<0.2%), were not censored but instead matched with two new controls. Individuals with type 2 diabetes were evaluated according to the number of PAD risk factors beyond recommended guideline levels at baseline, including LDL 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 individuals with type 2 diabetes. The adjusted hazard ratio for PAD was 1.41 (95% CI 1.23–1.63) for those with type 2 diabetes with all PAD risk factors within target compared with controls matched for sex, age, and county but not risk factor status, in contrast with 9.28 (95% CI 3.62–23.79) for those with all five 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 individuals with type 2 diabetes.