{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,17]],"date-time":"2025-05-17T04:12:18Z","timestamp":1747455138484,"version":"3.40.5"},"reference-count":35,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2025,5,16]],"date-time":"2025-05-16T00:00:00Z","timestamp":1747353600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002842","name":"Chiang Mai University","doi-asserted-by":"publisher","award":["JRCMU2564_078, https:\/\/ora.oou.cmu.ac.th\/home\/"],"award-info":[{"award-number":["JRCMU2564_078, https:\/\/ora.oou.cmu.ac.th\/home\/"]}],"id":[{"id":"10.13039\/501100002842","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec013\">\n<jats:title>Objective<\/jats:title>\n<jats:p>This cohort study estimated the incidence and predictors of cardiovascular disease (CVD) and all-cause mortality among patients with type 2 diabetes mellitus (T2DM) and various stages of peripheral arterial disease (PAD) at the largest tertiary referral hospitals in upper-northern Thailand.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec014\">\n<jats:title>Methods<\/jats:title>\n<jats:p>This study recruited 278 T2DM and PAD patients for a 7-year cohort study. These patients completed health questionnaires and underwent physical examinations including ankle-brachial index measurements and clinical assessment to determine PAD severity. Mortality endpoints were determined using hospital death registers and national death records. The Cox proportional hazards and subdistribution hazard models were used to estimate PAD\u2019s effect on mortality, quantifying the association with hazard ratios (HR) and subdistribution hazard ratios (SHR).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec015\">\n<jats:title>Results<\/jats:title>\n<jats:p>PAD patients were categorized into three subgroups. Over seven years, the cumulative all-cause mortality rate was 36%, or 6.4 deaths per 100 person-years. Multivariable analysis revealed critical limb ischemia (CLI) patients had significantly higher risks of all-cause (HR 5.26, 95%CI 3.10\u20138.94) and CVD mortality (SHR 6.20, 95%CI 3.20\u201312.03) compared to their asymptomatic peers. No statistically significant differences in non-CVD mortality were noted across PAD subgroups.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec016\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>CLI, chronic kidney disease, and underweight (body mass index\u2009&lt;\u200918.5\u2009kg\/m<jats:sup>2<\/jats:sup>) emerged as independent mortality predictors. Conversely, asymptomatic PAD patients had a similar overall mortality risk as those with intermittent claudication. These findings highlight the need for risk stratification and patient empowerment to optimize management of these complex conditions.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0322502","type":"journal-article","created":{"date-parts":[[2025,5,16]],"date-time":"2025-05-16T17:37:01Z","timestamp":1747417021000},"page":"e0322502","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Incidence and predictors of cardiovascular disease mortality and all-cause mortality in patients with type II diabetes with peripheral arterial disease"],"prefix":"10.1371","volume":"20","author":[{"given":"Amaraporn","family":"Rerkasem","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ampica","family":"Mangklabruks","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Supawan","family":"Buranapin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-4484-6270","authenticated-orcid":true,"given":"Kiran","family":"Sony","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nimit","family":"Inpankaew","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rath","family":"Rerkasem","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sasinat","family":"Pongtam","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kochaphan","family":"Phirom","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0784-2449","authenticated-orcid":true,"given":"Kittipan","family":"Rerkasem","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,5,16]]},"reference":[{"key":"pone.0322502.ref001","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1186\/1744-8603-9-11","article-title":"Diabetes management in Thailand: a literature review of the burden, costs, and outcomes","volume":"9","author":"C Deerochanawong","year":"2013","journal-title":"Global Health"},{"key":"pone.0322502.ref002","volume-title":"IDF Diabetes Atlas 10th edition 2021","author":"Federation ID","year":"2021"},{"issue":"9901","key":"pone.0322502.ref003","doi-asserted-by":"crossref","first-page":"1329","DOI":"10.1016\/S0140-6736(13)61249-0","article-title":"Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis","volume":"382","author":"FGR Fowkes","year":"2013","journal-title":"Lancet"},{"key":"pone.0322502.ref004","article-title":"Thailand diabetes registry project: prevalence of vascular complications in long-standing type 2 diabetes","volume":"89","author":"R Leelawattana","year":"2006","journal-title":"J Med Assoc Thai"},{"issue":"6","key":"pone.0322502.ref005","doi-asserted-by":"crossref","first-page":"827","DOI":"10.4239\/wjd.v12.i6.827","article-title":"Diabetes and peripheral artery disease: A review","volume":"12","author":"DO Soyoye","year":"2021","journal-title":"World J Diabetes"},{"issue":"5","key":"pone.0322502.ref006","doi-asserted-by":"crossref","first-page":"577","DOI":"10.4239\/wjd.v5.i5.577","article-title":"Peripheral arterial disease, type 2 diabetes and postprandial lipidaemia: Is there a link?","volume":"5","author":"P Valdivielso","year":"2014","journal-title":"World J Diabetes"},{"key":"pone.0322502.ref007","article-title":"16. 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