Diabetes mellitus, smoking, and the risk for asymptomatic peripheral arterial disease: whom should we screen?

J Am Board Fam Pract. 2005 Sep-Oct;18(5):355-61. doi: 10.3122/jabfm.18.5.355.


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.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Brachial Artery / physiopathology
  • Comorbidity
  • Cross-Sectional Studies
  • Diabetes Mellitus / epidemiology*
  • Diabetes Mellitus / physiopathology
  • Diabetic Angiopathies / diagnosis
  • Female
  • Humans
  • Male
  • Mass Screening* / statistics & numerical data
  • Middle Aged
  • Peripheral Vascular Diseases / diagnosis*
  • Peripheral Vascular Diseases / epidemiology*
  • Peripheral Vascular Diseases / physiopathology
  • Regional Blood Flow
  • Risk Assessment
  • Smoking / epidemiology*
  • Smoking / physiopathology