Type 2 diabetes (T2D) and peripheral artery disease (PAD) are recognized as independent risk factors contributing to excess mortality. Contemporary observational studies exploring the associations of risk factors, and risk of all-cause and atherosclerotic cardiovascular disease mortality in persons with T2D following the onset of incident peripheral artery disease are limited. The objectives of this study were to investigate the associations of risk factors, and assess mortality risks in people with T2D compared with controls without T2D after the onset of PAD. All persons with T2D (n = 150,215) registered in the Swedish National Diabetes Register between 2005 and 2009 were included, along with 346,423 controls without T2D matched for sex and age. Data were retrieved from several national registries, capturing information on risk factors, onset of incident peripheral artery disease, other comorbidities, socioeconomic factors, and outcomes. To compare persons with T2D and controls following the onset of peripheral artery disease regarding the risk of all-cause, and atherosclerotic cardiovascular disease mortality, Cox proportional hazard models and Kaplan-Meier curves were employed. A gradient-boosting model was utilized to estimate the relative statistical contribution of risk factors to the modeling of incident mortality risk in people with both T2D and peripheral artery disease. Crude rates of incident all-cause mortality were higher in individuals with T2D compared with controls, following the onset of PAD (600.4 (95% CI, 581.4-619.8) per 10,000 person-years versus 549.1 (95% CI, 532.1-566.5) per 10,000 person-years). Persons with T2D had an adjusted hazard ratio (HR) for all-cause mortality of 1.12 (95% CI, 1.05–1.19, P < 0.01) compared with controls after onset of incident PAD. The comparable adjusted HR for cardiovascular mortality was 1.13 (95% CI, 1.07–1.19, P < 0.01). High age and hyperglycemia at baseline played a significant role in contributing to the predictive models for incident all-cause and cardiovascular mortality among individuals with both T2D and PAD. The presence of T2D with concomitant PAD is related to an increased risk of both all-cause and cardiovascular mortality compared with individuals with only PAD. This argues for implementing optimized and intensive treatment strategies for individuals with both conditions.

中文翻译：

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2 型糖尿病和外周动脉疾病患者全因和动脉粥样硬化性心血管疾病死亡的危险因素和风险：一项基于登记的观察性队列研究

2 型糖尿病 (T2D) 和外周动脉疾病 (PAD) 被认为是导致死亡率过高的独立危险因素。当代观察性研究探索 T2D 患者发生外周动脉疾病后的危险因素与全因和动脉粥样硬化性心血管疾病死亡风险之间的关系，但这些研究还很有限。本研究的目的是调查危险因素之间的关联，并评估 T2D 患者与非 T2D 对照者在 PAD 发病后的死亡风险。 2005 年至 2009 年间在瑞典国家糖尿病登记处登记的所有 T2D 患者 (n = 150,215) 以及性别和年龄匹配的 346,423 名未患 T2D 的对照者均被纳入其中。从多个国家登记处检索数据，获取有关风险因素、外周动脉疾病发病、其他合并症、社会经济因素和结果的信息。为了比较 T2D 患者和对照组在外周动脉疾病发作后的全因风险和动脉粥样硬化性心血管疾病死亡率，采用了 Cox 比例风险模型和 Kaplan-Meier 曲线。利用梯度增强模型来估计风险因素对 T2D 和外周动脉疾病患者事件死亡风险建模的相对统计贡献。 PAD 发病后，T2D 患者的全因死亡率粗略率高于对照组（每 10,000 人年 600.4 人（95% CI，581.4-619.8），而每 10,000 人年则为 549.1（95% CI，532.1-566.5）每 10,000 人年）。发生 PAD 后，与对照组相比，T2D 患者的全因死亡率调整后风险比 (HR) 为 1.12（95% CI，1.05-1.19，P < 0.01）。心血管死亡率的可比调整 HR 为 1.13（95% CI，1.07-1.19，P < 0.01）。基线时的高龄和高血糖在 T2D 和 PAD 患者全因事件和心血管死亡率的预测模型中发挥了重要作用。与仅患有 PAD 的个体相比，伴有 PAD 的 T2D 与全因死亡率和心血管死亡率风险增加有关。这主张对患有这两种疾病的个体实施优化和强化治疗策略。