Journal List > J Korean Soc Endocrinol > v.21(4) > 1063872

Rhee, Oh, Choi, Kim, Cha, Lee, Ha, Lee, Park, Chung, Kim, Lee, Koong, Park, Min, and Kim: Multi-country Study on the Prevalence and Clinical Features of Peripheral Arterial Disease in Type 2 Diabetic Patients Who are at High Risk for Atherosclerosis



PAD-SEARCH (Peripheral Arterial Disease - Screening and Evaluation of diabetic patients in Asian Regions Characterized by High risk factors) is the first international study to investigate the prevalence of peripheral arterial disease (PAD) in Asian type 2 diabetic patients and to demonstrate the relationships between the putative risk factors and PAD in this population.


A total of 6,625 type 2 diabetic patients (2,873 males and 3,752 females aged 50 and older) were enrolled in PAD-SEARCH in Korea, China, Taiwan, Hong Kong, Indonesia, Thailand and Philippines from October 2003 to March 2004. The Fukuda vascular profile VS-1000™ was used to determine the ankle-brachial index (ABI) and the brachial-ankle pulse wave velocity (baPWV).


The mean patient age was 63.7 ± 8.2 years and the mean duration of diabetes was 10.3 ± 8.0 years. 1,172 (17.7%) subjects were diagnosed as PAD by the ABI (≤ 0.9). Subjects with PAD had a significantly longer duration of diabetes or hypertension, a higher HbA1c level and a significantly lower mean BMI than did the non-PAD subjects. In terms of the lipid profiles, triglyceride was the only significant variable. Notably, the mean ABI and baPWV in the females were significantly poorer than the age matched males for the in subjects with a normal ABI. However, the mean ABI and baPWV in males were significantly poorer than those of the age matched females for the subjects with PAD. On the multivariate analysis, gender, age, BMI, smoking status, duration of diabetes and a previous history of cerebrovascular disease were identified as the independent risk factors of PAD.


These findings suggest that PAD is a common complication in Asian type 2 diabetic patients. Therefore, PAD screening and treatment should be emphasized for Asian diabetic patients with high risk factors.

Figures and Tables

Fig. 1
Age and gender specific direct standardized prevalence of PAD in Asian patients with type 2 diabetes mellitus.
Table 1
Inclusion and exclusion criteria of the PAD-SEARCH study subjects

CVA, cerebrovascular accident; MI, myocardial infarction.

Table 2
Clinical characteristics of study subjects

Mean ± SD.

DM, diabetes mellitus; HTN, hypertension; HDL, high density lipoprotein; LDL, low density lipoprotein.

Table 3
Mean ABI and baPWV values of the subjects determined using VS-1000™

Mean ± SD.

ABI, ankle-brachial index; baPWV, brachial-ankle pulse wave velocity.

Table 4
Comparison of subjects according to the presence and severity of PAD

Mean ± SD.

DM, diabetes mellitus; HTN, hypertension; HDL, high density lipoprotein; LDL, low density lipoprotein; ABI, ankle-brachial index; baPWV, brachial-ankle pulse wave velocity.

Table 5
Comparison of subjects by age

Mean ± SD.

ABI, ankle-brachial index; baPWV, brachial-ankle pulse wave velocity.

Table 6
Adjusted odds ratio of PAD for the different independent indicators

CVD, cerebrovascular disease; DM, diabetes mellitus; IHD, ischemic heart disease; OHA, oral hypoglycemic agent; PAD, peripheral arterial disease.


1. Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: Analysis of worldwide data. Lancet. 2005. 365:217–223.
2. Yanovski SZ, Yanovski JA. Obesity. N Engl J Med. 2002. 346:591–602.
3. King H, Aubert RE, Herman WH. Global burden of diabetes, 1995-2025: Prevalence, numerical estimates, and projections. Diabetes Care. 1998. 21:1414–1431.
4. Fuster V, Gotto AM Jr. Risk reduction. Circulation. 2000. 102:suppl 4. IV94–IV102.
5. Hirsch AT, Criqui MH, Treat-Jacobson D, Regensteiner JG, Creager MA, Olin JW, Krook SH, Hunninghake DB, Comerota AJ, Walsh ME, McDermott MM, Hiatt WR. Peripheral arterial disease detection, awareness, and treatment in primary care. JAMA. 2001. 286:1317–1324.
6. McDermott MM, Kerwin DR, Liu K, Martin GJ, O'Brien E, Kaplan H, Greenland P. Prevalence and significance of unrecognized lower extremity peripheral arterial disease in general medicine practice. J Gen Intern Med. 2001. 16:384–390.
7. Newman AB, Siscovick DS, Manolio TA, Polak J, Fried LP, Borhani NO, Wolfson SK. Cardiovascular heart study (CHS) collaborative research group. Ankle-arm index as a marker of atherosclerosis in the cardiovascular health study. Circulation. 1993. 88:837–845.
8. Leng GC, Lee AJ, Fowkes FG, Whiteman M, Dunbar J, Housley E, Ruckley CV. Incidence, natural history and cardiovascular events in symptomatic and asymptomatic peripheral arterial disease in the general population. Int J Epidemiol. 1996. 25:1172–1181.
9. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA. 2001. 285:2486–2497.
10. Smith FB, Lowe GD, Lee AJ, Rumley A, Leng GC, Fowkes FG. Smoking, hemorheologic factors, and progression of peripheral arterial disease in patients with claudication. J Vasc Surg. 1998. 28:129–135.
11. Fowkes FG, Housley E, Riemersma RA, Macintyre CC, Cawood EH, Prescott RJ, Ruckley CV. Smoking, lipids, glucose intolerance, and blood pressure as risk factors for peripheral atherosclerosis compared with ischemic heart disease in the Edinburgh artery study. Am J Epidemiol. 1992. 135:331–340.
12. Hooi JD, Stoffers HE, Kester AD, Rinkens PE, Kaiser V, van Ree JW, Knottnerus JA. The Limburg PAOD Study. Peripheral Arterial Occlusive Disease. Risk factors and cardiovascular diseases associated with asymptomatic peripheral arterial occlusive disease. Scand J Prim Health Care. 1998. 16:177–182.
13. Lowe GD, Fowkes FG, Dawes J, Donnan PT, Lennie SE, Housley E. Blood viscosity, fibrinogen, and activation of coagulation and leukocytes in peripheral arterial disease and the normal population in the Edinburgh artery study. Circulation. 1993. 87:1915–1920.
14. Murabito JM, D'Agostino RB, Silbershatz H, Wilson WF. Intermittent claudication. A risk profile from the Framingham heart study. Circulation. 1997. 96:44–49.
15. Leibson CL, Ransom JE, Olson W, Zimmerman BR, O'Fallon WM, Palumbo PJ. Peripheral arterial disease, diabetes, and mortality. Diabetes Care. 2004. 27:2843–2849.
16. Gregg EW, Sorlie P, Paulose-Ram R, Gu Q, Eberhardt MS, Wolz M, Burt V, Curtin L, Engelgau M, Geiss L. Prevalence of lower-extremity disease in the US adult population ≥ 40 years of age with and without diabetes: 1999-2000 National Health and Nutrition Examination Survey. Diabetes Care. 2004. 27:1591–1597.
17. Dolan NC, Liu K, Criqui MH, Greenland P, Guralnik JM, Chan C, Schneider JR, Mandapat AL, Martin G, McDermott MM. Peripheral artery disease, diabetes, and reduced lower extremity functioning. Diabetes Care. 2002. 25:113–120.
18. Hiatt WR. Medical treatment of peripheral arterial disease and claudication. N Engl J Med. 2001. 344:1608–1621.
19. Kubo T, Miyata M, Minagoe S, Setoyama S, Maruyama I, Tei C. A simple oscillometric technique for determining new indices of arterial distensibility. Hypertens Res. 2002. 25:351–358.
20. Yamashina A, Tomiyama H, Takeda K, Tsuda H, Arai T, Hirose K, Koji Y, Hori S, Yamamoto Y. Validity, reproducibility, and clinical significance of noninvasive brachial-ankle pulse wave velocity measurement. Hypertens Res. 2002. 25:359–364.
21. Weisell RC. Body mass index as an indicator of obesity. Asia Pac J Clin Nutr. 2002. 11:suppl 8. S681–S684.
22. Meijer WT, Hoes AW, Rutgers D, Bots ML, Hofman A, Grobbee DE. Peripheral arterial disease in the elderly: The Rotterdam study. Arterioscler Thromb Vasc Biol. 1998. 18:185–192.
23. Gofin R, Kark JD, Friedlander Y, Lewis BS, Witt H, Stein Y, Gotsman MS. The Jerusalem lipid research clinic prevalence study. Peripheral vascular disease in a middle-aged population sample. Isr J Med Sci. 1987. 23:157–167.
24. Criqui MH, Fronek A, Barrett-Connor E, Klauber MR, Gabriel S, Goodman D. The prevalence of peripheral arterial disease in a defined population. Circulation. 1985. 71:510–515.
25. O'Rourke MF, Pauca A, Jiang XJ. Pulse wave analysis. Br J Clin Pharmacol. 2001. 51:507–522.
26. Tseng CH. Prevalence and risk factors of peripheral arterial obstructive disease in Taiwanese type 2 diabetic patients. Angiology. 2003. 54:331–338.
27. Uusitupa MI, Niskanen LK, Siitonen O, Voutilainen E, Pyorala K. 5-year incidence of atherosclerotic vascular disease in relation to general risk factors, insulin level, and abnormalities in lipoprotein composition in non-insulin-dependent diabetic and nondiabetic subjects. Circulation. 1990. 82:27–36.
28. MacGregor AS, Price JF, Hau CM, Lee AJ, Carson MN, Fowkes FG. The Edinburgh artery study. Role of systolic blood pressure and plasma triglycerides in diabetic peripheral arterial disease. Diabetes Care. 1999. 22:453–458.
Similar articles