title: Novel risk factors for peripheral arterial disease in young women.
abstract: OBJECTIVE
  To investigate traditional and novel risk factors (homocysteine and C-reactive protein levels, and exposure to infections) for peripheral arterial disease in young women.
  
  
  METHODS
  In a multicenter, population-based, case-control study, 212 young women (mean [+/- SD] age, 48.2 +/- 7.0 years) with peripheral arterial disease and 475 healthy control women (mean age, 45.5 +/- 8.1 years) completed a standardized questionnaire and provided blood samples. Peripheral arterial disease was angiographically confirmed if a stenotic lesion (more than 50% reduction of the lumen) was present in at least one major peripheral artery. Hyperhomocysteinemia was defined as a nonfasting plasma homocysteine level exceeding the 90th percentile of the control group. History of infectious diseases was determined by questionnaire.
  
  
  RESULTS
  Elevated C-reactive protein levels were associated with an increased likelihood of peripheral arterial disease (odds ratio [OR] = 3.9; 95% confidence interval [CI]: 1.8 to 8.5 for women in the third quartile; OR = 3.1; 95% CI: 1.4 to 6.8 for women in the fourth quartile; both comparisons with women in the first quartile). Hyperhomocysteinemia was not associated with a significantly increased risk of peripheral arterial disease (OR = 1.6; 95% CI: 0.9 to 3.0). A history of chickenpox, shingles, mumps, pneumonia, chronic bronchitis, peptic ulcer, or periodontitis was independently related to peripheral arterial disease, with adjusted odds ratios varying from 1.7 (95% CI: 1.0 to 3.1) for mumps to 3.4 (95% CI: 1.5 to 7.7) for peptic ulcer. The risk of peripheral arterial disease increased with the number of these infections; exposure to five or more infections increased the odds 3.7-fold (95% CI: 1.7 to 8.2). This association was not affected by the level of C-reactive protein.
  
  
  CONCLUSIONS
  Our results do not support a strong relation between homocysteine and peripheral arterial disease in young women. However, an elevated C-reactive protein level and several types of symptomatic infection were associated with peripheral arterial disease.
authors.affiliation: Julius Center for General Practice and Patient Oriented Research, Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Daisy G M
authors.initials: DG
authors.lastname: Bloemenkamp
authors.forename: Maurice A A J
authors.initials: MA
authors.lastname: van den Bosch
authors.forename: Willem P Th M
authors.initials: WP
authors.lastname: Mali
authors.forename: Bea C
authors.initials: BC
authors.lastname: Tanis
authors.forename: Frits R
authors.initials: FR
authors.lastname: Rosendaal
authors.forename: Jeanet M
authors.initials: JM
authors.lastname: Kemmeren
authors.forename: Ale
authors.initials: A
authors.lastname: Algra
authors.forename: Frank L J
authors.initials: FL
authors.lastname: Visseren
authors.forename: Yolanda
authors.initials: Y
authors.lastname: van der Graaf
mesh_terms: D001161:Arteriosclerosis / Q000097:blood / Q000209:etiology*; D002097:C-Reactive Protein / Q000032:analysis*; D016022:Case-Control Studies; D005260:Female; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D007239:Infections / Q000150:complications*; D007866:Leg / Q000098:blood supply; D008875:Middle Aged; D016017:Odds Ratio; D016491:Peripheral Vascular Diseases / Q000097:blood / Q000209:etiology*; D012307:Risk Factors
chemical_list: D006710:Homocysteine; D002097:C-Reactive Protein