Risk factors for premature peripheral vascular disease: results for the National Health and Nutritional Survey, 1999-2002.
OBJECTIVE
Premature peripheral vascular disease (PVD), occurring <60 years of age, is associated with significant cardiovascular morbidity, limb loss, and death. We hypothesized that different risk factors predict the development of PVD in patients <60 years than in patients > or =60 years.


METHODS
To address this question, we conducted a population-based observational study using the National Health and Nutritional Survey (NHANES) data set, which represents the noninstitutionalized civilian population in the United States. From 1999 to 2002, 5083 participants were analyzed as part of the NHANES survey. PVD status was defined by an ankle-brachial index (ABI) of <0.9. Putative risk factors for the development of PVD were collected by physical examination, interview, and laboratory testing. Univariate and multivariate logistic regression analyses were used to evaluate interactions between age strata and the development of PVD.


RESULTS
Premature PVD was found in 2.1% +/- 0.2% of the population <60 years, and PVD was found in 12.0% +/- 0.8% of the population > or =60 years. This corresponds to approximately 1.44 million people with premature PVD. Multivariate analysis determined coronary artery disease (odds ratio [OR] 2.90 vs 1.26, P = .083) and elevated serum fibrinogen (OR 1.07 vs 1.03, P = .034) were stronger predictors of PVD in subjects <60 years than in older subjects. Chronic renal insufficiency (OR 1.02 vs 1.16, P = .006) was more highly predictive of PVD in subjects >60 years. Other significant predictors, irrespective of age, in the multivariate model included hypertension (OR 1.99, P < .001), smoking (OR 2.22, P < .001), and serum homocysteine (OR 1.27, P = .067).


CONCLUSIONS
Clinicians should be aware of the high risk of developing premature PVD in patients <60 years with coexisting coronary artery disease or elevated plasma fibrinogen. Routine screening by ABI measurements in high-risk patients would enhance the detection of subclinical premature PVD and allow for secondary intervention.
Lane
John S
JS
Department of Surgery, University of California, San Francisco, CA, USA.
Vittinghoff
Eric
E
Lane
Karen T
KT
Hiramoto
Jade S
JS
Messina
Louis M
LM
D017668:Age of Onset; D000842:Ankle / Q000098:blood supply*; D001794:Blood Pressure; D001916:Brachial Artery / Q000503:physiopathology; D003324:Coronary Artery Disease / Q000150:complications* / Q000503:physiopathology; D003710:Demography; D005260:Female; D005340:Fibrinogen / Q000378:metabolism; D006306:Health Surveys; D006710:Homocysteine / Q000097:blood; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009749:Nutrition Surveys; D016491:Peripheral Vascular Diseases / Q000097:blood / Q000453:epidemiology / Q000209:etiology*; D015995:Prevalence; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
D006710:Homocysteine; D005340:Fibrinogen