Prevalence of Peripheral Arterial Disease and Associated Risk Factors in American Indians: The Strong Heart Study

Abstract

Studies of peripheral arterial disease (PAD) in minority populations provide researchers with an opportunity to evaluate PAD risk factors and disease severity under different types of conditions. Examination 1 of the Strong Heart Study (1989-1992) provided data on the prevalence of PAD and its risk factors in a sample of American Indians. Participants (N = 4,549) represented 13 tribes located in three geographically diverse centers in the Dakotas, Oklahoma, and Arizona. Participants in this epidemiologic study were aged 45-74 years; 60% were women. Using the single criterion of an ankle brachial index less than 0.9 to define PAD, the prevalence of PAD was approximately 5.3% across centers, with women having slightly higher rates than men. Factors significantly associated with PAD in univariate analyses for both men and women included age, systolic blood pressure, hemoglobin A1c level, albuminuria, fibrinogen level, fasting glucose level, prevalence of diabetes mellitus, and duration of diabetes. Multiple logistic regression analyses were used to predict PAD for women and men combined. Age, systolic blood pressure, current cigarette smoking, pack-years of smoking, albuminuria (micro- and macro-), low density lipoprotein cholesterol level, and fibrinogen level were significantly positively associated with PAD. Current alcohol consumption was significantly negatively associated with PAD. In American Indians, the association of albuminuria with PAD may equal or exceed the association of cigarette smoking with PAD.

Risk factors of peripheral arterial disease and relationship between low ankle brachial index and mortality from all-cause and cardiovascular disease in Chinese patients with hypertension

“…In other words, a patient has a higher risk of all-cause and CVD mortality with a lower ABI. The adjusted risk of all-cause and CVD mortality for the 0.91-0.99 group, defined as the equivocal ABI level by PAD guidelines, 19 was not significantly different from the 1.00-1.40 group in this study.…”

“…18 This cutoff point has also been accepted by the Strong Heart Study (SHS) where the upper limit of normal ABI should not exceed 1.40. 19 More recently, the American College of Cardiology and the American Heart Association (ACC/AHA) guidelines have recommended ABI p0.90 as the criterion for the diagnosis of PAD. 20 Thus, our study adopted this recommendation for participants with an ABI p0.90 in either leg as low ABI.…”

Relationship of High and Low Ankle Brachial Index to All-Cause and Cardiovascular Disease Mortality

“…24,25 This cutpoint has been related to prevalent and incident CVD and all-cause mortality in several studies 1,2,5,7,8 and has been used in other studies of American Indians 26 and in previous work in the SHS. 3 Participants who had an ABI Ͻ0.90 in either leg were categorized as having low ABI.…”

“…[1][2][3] Prospective studies using the ankle brachial index (ABI) have shown that a low ABI predicts fatal and nonfatal CHD and all-cause mortality in people with and without existing clinical coronary artery disease and among people with existing peripheral vascular disease. 4 -10 Low ABI has been linked with incident stroke in the elderly.…”

Albuminuria and peripheral arterial disease: Results from the Multi-Ethnic Study of Atherosclerosis (MESA)

“…However, the role of albuminuria as a risk factor for PAD has been evaluated in mostly small studies. These studies suggest that albuminuria may be an important risk factor for PAD in the general population [10,11] and in high risk populations of diabetic subjects [12][13][14][15] or hypertensive subjects [16,17]. The hypothesis of this study was that albuminuria is associated positively with PAD in a racially diverse group of diabetic and nondiabetic subjects without a history of CVD.…”