Cardiovascular disease is the leading cause of death worldwide and its prevalence is on the rise, especially in developing countries.1,2 Diabetes is among the leading causes of morbidity and mortality as well, with similar trends in prevalence.3 Diabetes is a well-known risk factor for cardiovascular complications including coronary, cerebrovascular and peripheral artery disease (PAD). Hospitalized patients with diabetes are more likely to suffer of major adverse cardiovascular events (MACE) including myocardial infarction, stroke, or sudden cardiac death.4, 5, 6

Diabetic foot ulcers (DFU) are a frequent complication of diabetes, with a lifetime incidence estimated between 19 and 34 %, often mandating amputation, associated with poor prognosis.7 The underlying pathophysiology of DFU is multifactorial. Diabetic neuropathy can lead to chronic structural changes in foot morphology increasing localized pressure points. Moreover, sensory neuropathy may lead to loss of protective sensation as well as to impairment of the inflammatory response to injury. Approximately 50 % of the ulcers will present with localized infection requiring antibiotics and some kind of local intervention (usually debridement).8,9 Peripheral vascular disease is present in over 50 % of the patients admitted to the hospital with an acute diabetic foot (i.e. acute or subacute infection or ischemia), whereby early revascularization when possible is of utmost importance for limb salvage.10

Infected diabetic foot ulcers are of great concern, since the mortality rate as well as the amputation rate is considerably high. Prompt treatment including hospitalization for debridement, antibiotic treatment directed by deep cultures where possible, as well as vascular assessment and intervention, has been shown to improve outcomes. Previous research has shown that the involvement of a multi-disciplinary team in patient care plays a pivotal part in improved outcomes of these patients.8

Polyvascular disease (PD), is the term given for the presence of atherosclerosis in two or more arterial beds (peripheral, coronary or cerebrovascular). This entity was largely considered inconsequential as atherosclerotic treatment was usually uniform irrespective of the number of involved vascular beds. Bhatt et al. nearly two decades ago, demonstrated in the REACH registry studies that these patients suffer of poor outcomes compared to single vascular disease patients thus mandating more aggressive control of cardiovascular risk factors.11,12

Patients with PD are far more likely to experience MACE compared to patients with disease involving only a single vascular bed.6,13,14 Despite its possible prognostic implications, the true prevalence of PD is uncertain as the inclusion criteria vary between studies not designed for epidemiological purposes. Gutierrez et al. reviewed the secondary analyses of multiple randomized controlled studies (RCT's) as well as two observational studies: CRUSADE and REACH.14 In the RCT's the prevalence of PD was highly related to the inclusion criteria of the trial and did not reflect the overall population. The authors proposed selective recruitment of patients with PD for future studies. In the REACH registry, patients enrolled had either proven atherosclerotic disease (nearly half of the enrolled population) or at least 3 atherosclerotic risk factors. In this study the prevalence of PD reached 16 %.11

Data on prevalence and outcomes of patients with PD hospitalized with DFU is scarce.15 This study aims to compare the baseline characteristics and outcomes of patients hospitalized with a DFU suffering of PD to those not suffering of PD.