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Cardiovascular and Limb Outcomes in Patients With Diabetes and Peripheral Artery Disease: The EUCLID Trial.

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Date
2018-12
Authors
Low Wang, Cecilia C
Blomster, Juuso I
Heizer, Gretchen
Berger, Jeffrey S
Baumgartner, Iris
Fowkes, F Gerry R
Held, Peter
Katona, Brian G
Norgren, Lars
Jones, W Schuyler
Lopes, Renato D
Olin, Jeffrey W
Rockhold, Frank W
Mahaffey, Kenneth W
Patel, Manesh R
Hiatt, William R
EUCLID Trial Executive Committee and Investigators
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Abstract
BACKGROUND:Diabetes confers an increased risk for atherosclerotic cardiovascular disease, but less is known about the independent risk diabetes confers on major cardiovascular and limb events in patients with symptomatic peripheral artery disease (PAD) on contemporary management. OBJECTIVES:The authors sought to assess the risk of cardiovascular and limb events in patients with PAD and diabetes as compared with those with PAD alone. METHODS:In the EUCLID (Examining Use of Ticagrelor in Peripheral Artery Disease) trial, 13,885 patients with symptomatic PAD were evaluated with a primary endpoint of an adjudicated composite of major adverse cardiovascular events (MACE) (cardiovascular death, myocardial infarction, ischemic stroke) followed over a median of ∼30 months. The diabetes subgroup was analyzed compared with the subgroup without diabetes, and further examined for diabetes-specific factors such as glycosylated hemoglobin (HbA1c) that might affect risk for major cardiovascular and limb outcomes. RESULTS:A total of 5,345 patients (38.5%) had diabetes; the majority (n = 5,134 [96.1%]) had type 2 diabetes. The primary endpoint occurred in 15.9% of patients with PAD and diabetes as compared with 10.4% of those without diabetes (absolute risk difference 5.5%; adjusted hazard ratio: 1.56; 95% confidence interval [CI]: 1.41 to 1.72; p < 0.001). Every 1% increase in HbA1c was associated with a 14.2% increased relative risk for MACE (95% CI: 1.09 to 1.20; p < 0.0001). CONCLUSIONS:Patients with PAD and diabetes are at high risk for cardiovascular and limb ischemic events, even on contemporary therapies. Every 1% increase in HbA1c was associated with a 14.2% increased relative risk for MACE (95% CI: 1.09 to 1.20; p < 0.0001). (A Study Comparing Cardiovascular Effects of Ticagrelor and Clopidogrel in Patients With Peripheral Artery Disease [EUCLID]; NCT01732822).
Type
Journal article
Subject
EUCLID Trial Executive Committee and Investigators
Lower Extremity
Humans
Ischemia
Diabetes Mellitus, Type 2
Platelet Aggregation Inhibitors
Treatment Outcome
Aged
Middle Aged
Female
Male
Peripheral Arterial Disease
Ticagrelor
Permalink
https://hdl.handle.net/10161/19417
Published Version (Please cite this version)
10.1016/j.jacc.2018.09.078
Publication Info
Low Wang, Cecilia C; Blomster, Juuso I; Heizer, Gretchen; Berger, Jeffrey S; Baumgartner, Iris; Fowkes, F Gerry R; ... EUCLID Trial Executive Committee and Investigators (2018). Cardiovascular and Limb Outcomes in Patients With Diabetes and Peripheral Artery Disease: The EUCLID Trial. Journal of the American College of Cardiology, 72(25). pp. 3274-3284. 10.1016/j.jacc.2018.09.078. Retrieved from https://hdl.handle.net/10161/19417.
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Scholars@Duke

Jones

William Schuyler Jones

Associate Professor of Medicine
I am an interventional cardiologist with a specific focus on the diagnosis and treatment of patients with cardiovascular disease. As a clinician, I see patients in the office and do coronary and peripheral vascular procedures (angiography and interventions) in the Duke Cardiac Catheterization Laboratory. I have served as the Medical Director of the cath lab at Duke since 2016. Alongside my partners in the cath lab, we collaborate with our cardiothoracic surgeons to hold Heart Team meetings each
Lopes

Renato Delascio Lopes

Professor of Medicine
Atrial Fibrillation Antithrombotic Therapy in patients with Acute Coronary Syndromes Elderly patients with Heart Disease Biomarkers in Acute Coronary Syndromes and Atrial Fibrillation Thrombosis and Anticoagulation and novel antithrombotic agents Metabolomics in Cardiovascular Medicine
Patel

Manesh Raman Patel

Richard Sean Stack, M.D. Distinguished Professor
Manesh Patel is the Chief of the Division of Cardiology and the Division of Clinical Pharmacology.  His clinical interests include diagnostic and interventional coronary angiography, peripheral angiography and endovascular intervention.  His is involved in several clinical trials involving patients with cardiovascular disease and in cardiac imaging.  He is also the Chair of the American College of Cardiology Task Force for Appropriate Use Criteria for Cardiovascular Procedures and
Rockhold

Frank Wesley Rockhold

Professor of Biostatistics & Bioinformatics
Frank is a full time Professor of Biostatistics and Bioinformatics and Faculty Director for Biostatistics at Duke University Medical Center, Affiliate Professor of Biostatistics at Virginia Commonwealth University, and Strategic Consultant at Hunter Rockhold, Inc.  His 40+-year career includes senior research positions at Lilly, Merck, and GlaxoSmithKline, where he retired as Chief Safety Officer and Senior Vice President of Global Clinical Safety and Pharmacovigilance.  He h
Alphabetical list of authors with Scholars@Duke profiles.
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