Objective: Homeostatic glucose control may play an important role in the development of peripheral arterial disease among individuals without diabetes. We sought to evaluate the association of HbA(1c) (A1C) with peripheral arterial disease in a representative sample of the U.S. population with and without diabetes.
Research design and methods: A cross-sectional study was conducted among 4,526 National Health and Nutrition Examination Survey 1999-2002 participants > or = 40 years of age. Peripheral arterial disease was defined as an ankle-brachial index <0.9 (n = 327).
Results: Among nondiabetic subjects, the age-standardized prevalence of peripheral arterial disease was 3.1, 4.8, 4.7, and 6.4% for participants with an A1C <5.3, 5.3-5.4, 5.5-5.6, and 5.7-6.0%, respectively (P trend <0.001). The prevalence of peripheral arterial disease was 7.5 and 8.8% for diabetic participants with A1C <7 and > or = 7%, respectively. After multivariable adjustment and compared with nondiabetic participants with A1C <5.3%, the odds ratio (95% CI) of peripheral arterial disease for nondiabetic participants with an A1C of 5.3-5.4, 5.5-5.6, and 5.7-6.0% was 1.41 (0.85-2.32), 1.39 (0.70-2.75), and 1.57 (1.02-2.47), respectively, and it was 2.33 (1.15-4.70) and 2.74 (1.25-6.02) for diabetic participants with A1C <7 and > or = 7%, respectively.
Conclusions: An association exists between higher levels of A1C and peripheral arterial disease, even among patients without diabetes. Individuals with A1C levels > or = 5.3% should be targeted for aggressive risk factor reduction, which may reduce the burden of subclinical cardiovascular disease even among those without diabetes.