Can obstructive peripheral arterial disease be a marker for coronary artery disease in patients with diabetic foot ulcers?

Objective: Diabetic foot ulcers (DFUs) are a serious complication of diabetes that is often associated with peripheral arterial disease (PAD). Although PAD is associated with poor wound healing and a greater risk of amputation, its possible correlation with coronary artery disease (CAD) in patients with DFUs remains unclear. The aim of this study was to determine whether PAD can serve as an indicator of CAD in patients with DFUs. Method: This retrospective study included patients with DFUs who were treated between 2018–2022 at the Ankara University Faculty of Medicine Wound Care Unit. Patients were categorised into two groups: those with and those without PAD. PAD was additionally categorised according to the arterial involvement level as either above-ankle level (AAL) or below-ankle level (BAL). The occurrence of CAD was compared across these groups. A multivariable logistic regression analysis was performed to adjust for age, sex, hypertension and chronic kidney disease. Results: The experimental cohort comprised 190 patients with DFUs. A total of 58.4% of patients with DFUs had PAD. The incidence of CAD in the PAD group was significantly greater (53.1%; 95% confidence interval (CI): 43.9%, 62.2%) than that in the non-PAD group (35.4%; 95% CI: 23.7%, 47.1%) (p=0.016). Regarding the two subgroups of PAD patients, the CAD incidence was 55.8% in AAL patients and 46.9% in BAL patients; the variation was not statistically significant (p=0.399). In the adjusted model, PAD was not independently associated with CAD (adjusted odds ratio (OR): 0.71; 95% CI: 0.25, 2.00; p=0.512), whereas male sex remained a significant predictor (adjusted OR: 4.28; 95% CI: 1.09, 16.82; p=0.037). Conclusion: Among patients with DFUs, PAD was associated with a higher prevalence of CAD; however, this association was not independent after adjustment for major comorbidities. These findings suggest that PAD indicates a higher cardiovascular risk rather than serving as a predictive marker for CAD. However, the level of PAD involvement does not seem to be related to CAD incidence. These findings emphasise the importance of cardiovascular screening in patients with DFUs and PAD to improve treatment strategies and avoid adverse consequences.