Medial arterial calcification of the foot arteries is associated with incident cardiovascular events or all-cause mortality in patients with diabetes-related foot ulceration
Authors' conclusion
pMAC is associated with MACE or all-cause mortality in patients with DFU, with infected ulcers heightening the risk of MACE.
Study context
- Population
- Adults with DFU; Pedal medial arterial calcification (pMAC) assessed at five sites on foot x-ray
- Participants
- 509 adults
- Exposure
- No/low vs moderate vs severe pedal medial arterial calcification
- Outcome
- MACE (hospitalisation for MI, HF, stroke or transient ischaemic attack) and mortality
- Follow-up
- Median 531 days (IQR 288-793)
Methodological detailsProportions with no/low, moderate and severe pMAC: 55.2%, 23.4% and 21.4%
- Proportions with no/low, moderate and severe pMAC: 55.2%, 23.4% and 21.4%
Main finding
As reported in the abstract
MACE or all-cause mortality
Between Severe and No/low: log-rank p < 0.001 · Between Severe and No/low: P = 0.009
Observational data: associations, not effects.
Further findings
MACE · across no/low, moderate, severe
log-rank p = 0.020
| Outcome | P value |
|---|---|
| MACEMultivariable analysis; not associated | P = 0.299 |
| MACE by pMAC and infected ulcerBetween pMAC + infection and Neither · across four groups | log-rank p < 0.001 |
| MACE by pMAC and infected ulcerBetween pMAC + infection and Neither · after adjustment | P = 0.017 |
- Major adverse cardiovascular events (MACE) by pMAC and infected ulcer: pMAC + infection 25.0%
- MACE by pMAC and infected ulcer: pMAC only 12.5%
- MACE by pMAC and infected ulcer: Infection only 14.0%
- MACE by pMAC and infected ulcer: Neither 9.0%
Original publication
Medial arterial calcification of the foot arteries is associated with incident cardiovascular events or all-cause mortality in patients with diabetes-related foot ulceration. Diabetes Res Clin Pract. Published 15 January 2026. doi:10.
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