Pulmonary Dysfunction as a Predictor of Macrovascular Complications in Type 2 Diabetes: Exploring the Role of Airway Obstruction in Coronary and Peripheral Artery Disease

Background: Diabetes affects over 10% of the global adult population and is associated with significant macrovascular complications, including coronary artery disease (CAD) and peripheral artery disease (PAD). These conditions contribute to high morbidity, frequent hospitalizations, and premature mortality, including sudden cardiac death. Despite significant advances in cardiovascular research, the burden of these complications remains substantial. Conventional cardiometabolic risk factors do not fully account for the increased incidence of microvascular and macrovascular dysfunction in diabetes. This study explores the potential role of pulmonary dysfunction, specifically airway obstruction, as an additional contributing factor to macrovascular injury in individuals with type 2 diabetes (T2D). Objective: To investigate the relationship between pulmonary dysfunction and macrovascular complications (CAD and PAD) in adults with T2D. Hypothesis: Pulmonary dysfunction, particularly airway obstruction, is independently associated with an increased risk of CAD and PAD in individuals with T2D. Methods: This cross-sectional study included 596 adults with T2D who were managed at the National Diabetes Management and Research Center in Ghana. Spirometry was performed following the European Respiratory Society/American Thoracic Society (ERS/ATS) guidelines. Pulmonary function was categorized into normal, restrictive, obstructive, and mixed obstructive patterns based on FEV1/FVC and FVC values. Macrovascular dysfunction was assessed through the presence of CAD (using the Rose Angina Questionnaire, ECG findings) and PAD (defined by an ankle-brachial index ≤ 0.90). Multivariable logistic regression was used to examine associations between pulmonary dysfunction and macrovascular disease, adjusting for confounding variables such as age, sex, diabetes duration, HbA1c, blood pressure control, smoking, and BMI. Results: The study cohort was 76.5% female, with a mean age of 58.99 years and an average diabetes duration of 11.94 years. The prevalence of pulmonary dysfunction, PAD, and CAD was 48.2%, 11.4%, and 24.8%, respectively. Airway obstruction was nearly 80% more common in individuals with CAD (14.3% vs. 8.0%, p=0.048). However, no significant association was found between pulmonary restriction and CAD (42.0% vs. 43.1%, p=0.925) or PAD (43.8% vs. 44.3%, p=1.000). In adjusted multivariable models, airway obstruction was significantly associated with CAD (odds ratio = 4.00, 95% CI 1.27–12.65, p=0.018), whereas pulmonary restriction did not show significant associations with either CAD or PAD. Conclusion: Airway obstruction is independently associated with an increased risk of CAD in individuals with T2D, suggesting a potential role for pulmonary dysfunction in the pathophysiology of CAD. These findings highlight the importance of assessing pulmonary function in individuals with T2D, as it may offer valuable insights for identifying those at higher risk for CAD and guide strategies for prevention and management. Further research is needed to better understand the mechanisms linking pulmonary dysfunction with macrovascular disease in this population. This abstract was presented at the American Physiology Summit 2025 and is only available in HTML format. There is no downloadable file or PDF version. The Physiology editorial board was not involved in the peer review process.