Peripheral artery disease In West Africans with diabetes: a risk factor profile analysis

Background: Globally, peripheral artery disease (PAD) affects >200 million people, disproportionately affecting people with diabetes. Prior studies characterizing the risk profile of PAD in diabetes have excluded West Africans, whose vascular biology is relevantly different. This study characterized the aggregate effect of modifiable risk factors on PAD in West Africans with diabetes. Methods: This was a cross-sectional study among 803 Ghanaian adults with diabetes. PAD was defined as ankle-brachial pressure index ≤0.90 and/or intermittent claudication. A multivariate logistic regression model was built to identify modifiable PAD risk factors, which were used to define the number of risk factors for each participant. The odds of PAD were determined based on the number of modifiable risk factors. Results: The mean age, diabetes duration, and HbA₁c concentrations were 59.81(±9.95) years, 13.66(±7.89) years, and 8.45(±1.94) %, respectively. PAD prevalence was 25.8 %. In a multivariable regression model, hypertension [odds ratio 2.00, 95 % confidence interval 1.33–3.01], chronic kidney disease [1.54(1.11–2.14)], central obesity [1.58(1.05–2.39)], and elevated LDL-cholesterol concentration [1.42(1.02–1.97)] were independently associated with PAD. After adjustment for age, sex, and diabetes duration, the odds of PAD increased with each additional risk factor from a 2.02-fold increase [OR 2.02, 95 %CI 0.69–5.97) in the presence of two risk factors, to 3.51-fold [3.51(1.20–10.24)] for three risk factors, and nearly five-fold [4.80 (1.57–14.67)] for four risk factors. Conclusion: West Africans with diabetes are very sensitive to the cumulative effect of hypertension, chronic kidney disease, central obesity, and elevated LDL cholesterol concentration for PAD. These findings provide data to guide PAD screening/treatment strategies.