Cardiovascular and Limb Outcomes in Patients With Diabetes and Peripheral Artery Disease: The EUCLID Trial.
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 articleSubject
EUCLID Trial Executive Committee and InvestigatorsLower 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/10161/19417Published Version (Please cite this version)
10.1016/j.jacc.2018.09.078Publication 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.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
Collections
More Info
Show full item recordScholars@Duke
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
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
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
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.

Articles written by Duke faculty are made available through the campus open access policy. For more information see: Duke Open Access Policy
Rights for Collection: Scholarly Articles
Works are deposited here by their authors, and represent their research and opinions, not that of Duke University. Some materials and descriptions may include offensive content. More info