Lower extremity peripheral artery disease in the absence of traditional risk factors. The Multi-Ethnic Study of Atherosclerosis.
OBJECTIVE
Lower-extremity peripheral artery disease (LE-PAD), is strongly related to traditional risk factors (smoking, hypertension, dyslipidemia, diabetes). We hypothesized that the prevalence of LE-PAD in the absence of traditional CVD risk factors is not negligible, and that this condition would remain associated with subclinical atherosclerosis in other territories.


METHODS
In the Multi-Ethnic Study of Atherosclerosis, we classified participants without any traditional risk factor according to their ankle-brachial index (ABI) into 3 groups: low (<1.00), normal (1.00-1.30) and high (>1.30) ABI. Coronary or carotid artery diseases were defined by the presence of any coronary artery calcification (CAC score>0) or carotid plaque, respectively.


RESULTS
Among the 6814 participants, 1932 had no traditional risk factors. A low- and high ABI were found in 176 (9%) and 149 (7.8%) cases, respectively. Lower glomerular filtration rate (OR: 0.88/10 units, p=0.04) and higher Interleukin-6 levels (OR: 1.42/natural-log unit, p=0.02) were associated with low ABI. Past smoking (cessation>10 years) and pulse pressure had borderline association with low ABI. In adjusted models, low-ABI was significantly associated with CAC prevalence (OR: 1.22, p<0.03). No significant association was found with carotid plaque.


CONCLUSIONS
In the absence of traditional CVD risk factors, LE-PAD is still common and associated with coronary artery disease.
Dept. of Thoracic and Cardiovascular Surgery and Vascular Medicine, Dupuytren University Hospital, Limoges, France. vaboyans@ucsd.edu
Victor
V
Aboyans
Robyn L
RL
McClelland
Matthew A
MA
Allison
Mary McGrae
MM
McDermott
Roger S
RS
Blumenthal
Katarzyna
K
Macura
Michael H
MH
Criqui
D000368:Aged; D000369:Aged, 80 and over; D055109:Ankle Brachial Index; D050197:Atherosclerosis / Q000175:diagnosis* / Q000208:ethnology*; D002118:Calcium / Q000378:metabolism; D005006:Ethnicity; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D015850:Interleukin-6 / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000175:diagnosis* / Q000208:ethnology*; D012044:Regression Analysis; D012307:Risk Factors
D015850:Interleukin-6; D002118:Calcium