Prediabetes and the risk of peripheral artery disease: a meta-analysis.

Background: 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.

Methods: 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 two reviewers, and any discrepancies were resolved by consensus. Pooled relative risks (RRs) and 95% confidence intervals (CIs) were calculated using a random-effects model to account for heterogeneity among studies.

Results: A total of eight cohort studies comprising 90133 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 versus 0.92, p for subgroup difference = 0.02).

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