Prediabetes and the Risk of Peripheral Artery Disease: A Meta-Analysis

Peripheral artery disease (PAD) is a significant vascular condition that can lead to severe complications, including limb ischemia and cardiovascular events. This meta-analysis aims to evaluate the association between prediabetes, an intermediate state between normoglycemia and diabetes, and the risk of developing PAD.

A comprehensive search of PubMed, EMBASE, and Web of Science databases was conducted to identify relevant cohort studies up to April 12, 2024. Data extraction was performed independently by 2 reviewers, and any discrepancies were resolved by consensus. Pooled risk ratios (RRs) and 95% confidence intervals (CIs) were calculated using a random effects model to account for heterogeneity among studies.

A total of 8 cohort studies comprising 90,133 participants were included in the meta-analysis. The pooled analysis revealed that individuals with prediabetes had a significantly higher risk of PAD compared to those with normoglycemia (RR = 1.27; 95% CI: 1.13-1.42; P < 0.001; I² = 55%). Subgroup analyses indicated that the association was stronger in prediabetes defined by mildly elevated hemoglobin A1c (RR: 1.47) compared to those defined by impaired fasting glucose (RR: 1.21) or impaired glucose tolerance (RR: 1.17, p for subgroup difference <0.001). In addition, a stronger association was observed for studies reporting clinically diagnosed PAD compared to studies that included asymptomatic PAD (RR: 1.32 vs. 0.92; p for subgroup difference = 0.02).

This meta-analysis demonstrates a significant association between prediabetes and an increased risk of PAD in a generally community-derived population.