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The Journal of the American Board of Family Practice 18:355-361 (2005)
© 2005 American Board of Family Practice

Original Research

Diabetes Mellitus, Smoking, and the Risk for Asymptomatic Peripheral Arterial Disease: Whom Should We Screen?

Sharon L. Eason, MPH, Nancy J. Petersen, PhD, Maria Suarez-Almazor, MD, PhD, Barry Davis, MD, PhD and Tracie C. Collins, MD, MPH

From the Houston Center for Quality of Care and Utilization Studies, Houston Veterans Affairs Medical Center, Section of Health Services Research, Baylor College of Medicine (SLE, NJP, MS-A, TCC), Houston, TX; and The University of Texas School of Public Health (BD), Houston, TX

Correspondence: Corresponding author: Tracie C. Collins, MD, MPH, or Sharon Eason, MPH, Houston Center for Quality of Care and Utilization Studies (Veterans Affairs Medical Center), 2450 Holcombe Blvd. Suite 01Y (152), Houston, TX 77021 (e-mail: tcollins{at}bcm.tmc.edu or season{at}bcm.tmc.edu)

Objective: To describe coexisting medical conditions and lifestyle factors associated with asymptomatic peripheral arterial disease (PAD) in a population of white, African American, and Hispanic patients.

Study Design and Setting: White, African American, and Hispanic patients 50 years or older were recruited for this cross-sectional study from 4 primary care clinics in Houston, TX. Patients with an ankle-brachial index (ABI) < 0.9 and without leg symptoms typical of PAD were diagnosed with asymptomatic PAD.

Results: 403 patients were screened for PAD. Of these, 25 (6.2%) had asymptomatic PAD. Compared with patients without PAD, diabetes mellitus ([OR] 3.8; 95% CI 1.6, 9.0) and a history of smoking at least 1 pack of cigarettes per day ([OR] 2.5; 95% CI 1.1, 6.0) were significantly associated with asymptomatic PAD. An interaction effect existed between diabetes mellitus and smoking at least 1 pack of cigarettes per day. Diabetes mellitus combined with heavy smoking showed the highest predicted value positive (15%) and the highest specificity (92%). A lack of both demonstrated low rates for predicting asymptomatic PAD (predicted value positive, 1%).

Conclusion: The ankle-brachial index could become routine screening among patients with diabetes mellitus and/or who smoke.






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Copyright © 2005 by the American Board of Family Medicine.