Can you have Peripheral Artery Disease (PAD) without diabetes?

Peripheral Artery Disease Can Occur Without Diabetes

Yes, peripheral artery disease (PAD) can definitely occur in patients without diabetes, although diabetes significantly increases the risk and severity of PAD. 1

Epidemiology and Risk Factors

• PAD is defined as any atherosclerotic arterial occlusive disease below the level of the inguinal ligament, resulting in reduced blood flow to the lower extremity 1
• While approximately 50% of patients with diabetic foot ulcers have coexisting PAD, the remaining 50% develop PAD without diabetes 1
• Non-diabetic risk factors for PAD include:
  • Smoking 2
  • Hyperlipidemia 2
  • Hypertension 2
  • Advanced age 3

Clinical Presentation Differences

• PAD in patients without diabetes tends to:
  • Present with more typical symptoms like claudication 1
  • Have less severe arterial calcification 1
  • Progress more slowly than in diabetic patients 4
• Diabetic patients with PAD often lack typical symptoms such as claudication or rest pain, even with severe tissue loss 1
• Diagnostic testing is more straightforward in non-diabetic patients as they have less arterial calcification that can interfere with measurements 1

Diagnostic Approach

• All patients (diabetic and non-diabetic) should be evaluated for PAD with:
  • Medical history and foot pulse palpation 1
  • Ankle or pedal Doppler arterial waveforms 1
  • Ankle systolic pressure and ankle brachial index (ABI) 1
• An ABI <0.9 is useful for detecting PAD in non-diabetic patients 1
• The presence of triphasic pedal Doppler arterial waveforms strongly excludes PAD in both diabetic and non-diabetic patients 5
• Toe brachial index ≥0.75 largely excludes PAD 1

Mortality and Outcomes

• PAD increases mortality risk in both diabetic and non-diabetic patients compared to healthy controls 6
• Non-diabetic PAD patients have a 29% 10-year mortality rate versus 14% in age/sex-matched non-diabetic controls 6
• Diabetic PAD patients have significantly worse outcomes with a 58% 10-year mortality rate versus 19% in diabetic controls without PAD 6
• Diabetes increases the risk of death in PAD patients by 2.5 times compared to non-diabetic PAD patients 6

Management Considerations

• All patients with PAD (diabetic and non-diabetic) should receive:
  • Aggressive cardiovascular risk management 1
  • Smoking cessation support 1
  • Treatment of hypertension 1
  • Statin therapy 1
  • Low-dose aspirin or clopidogrel 1
• Revascularization decisions should be based on:
  • Morphological distribution of PAD 1
  • Availability of autogenous vein 1
  • Patient co-morbidities 1
  • Local expertise 1

Clinical Pitfalls to Avoid

• Don't assume PAD is absent just because pulses are palpable - even skilled examiners can detect pulses despite significant ischemia 1
• Don't attribute poor wound healing to microangiopathy in diabetic patients - macrovascular disease (PAD) is typically the cause 1
• Don't delay vascular imaging in patients with non-healing ulcers who have ankle pressure <50 mmHg or ABI <0.5 1
• Don't overlook PAD in patients with exertional leg symptoms but normal ABI - consider additional testing 5