title: Increased Prevalence of Moderate and Severe Peripheral Arterial Disease in the American Indian (AI)/Alaskan Native (AN) Population; a Study of 96,000 AI/AN.
abstract: BACKGROUND
  Peripheral arterial disease (PAD) disproportionally affects racial groups in the United States. Few studies have analyzed the rates of PAD in the American Indian (AI)/Alaskan Native (AN) population. In this article, we compare the prevalence of PAD in the AI/AN as compared with white and nonwhite Americans.
  
  
  METHODS
  The study data were provided by Life Line Screening (Independence, OH). The cohort consists of self-referred individuals who paid for vascular screening tests. Mild-to-moderate and severe PAD were defined as having an ankle-brachial index (ABI) in at least one extremity of < 0.9 and < 0.5, respectively. Univariate and multivariate analyses were performed to compare the rates of PAD between AI/AN, Caucasians, and nonwhites.
  
  
  RESULTS
  The original sample for which this study was obtained included 3,444,272 people. Of this group there was a predominance of females 64.5% (2,221,555) compared with 35.5% (1,222,716) males. The Native American/AN population was 2.8% of the sample (96,440). In our univariate analysis AI/AN had the highest rates of mild-moderate and severe PAD when compared with whites (odds ratio [OR] 1.78 and 2.14, respectively) and nonwhites (OR 1.52 and 1.82, respectively). We then controlled for atherosclerotic risk factors in our multivariate analysis, and the AI/NA cohort had persistently higher rates of both moderate and severe PAD compared with whites (OR 1.32 and 1.40) but not compared with nonwhites (OR 0.95 and 0.92).
  
  
  CONCLUSIONS
  Here we present the largest epidemiology study of PAD in AI/AN to date. AI/NA people have disproportionately high rates of both mild to-moderate and severe PAD when compared with whites and nonwhite Americans. After controlling for atherosclerotic risk factors the rates of PAD remain high for AI/NA when compared with whites but not when compared with nonwhites. While it is possible that a combination of diet and lifestyle choices are responsible for the high rates of PAD in this population, genetic factors may be involved as well, and deserve further investigation. Optimal medical management may help to prevent the complications of PAD in this patient population.
authors.affiliation: Division of Vascular Surgery, New York University Langone Medical Center, New York, NY.
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Baxter
authors.affiliation: Division of Vascular Surgery, New York University Langone Medical Center, New York, NY.
authors.forename: Glenn R
authors.initials: GR
authors.lastname: Jacobowitz
authors.affiliation: Division of Population Health, New York University Langone Medical Center, New York, NY.
authors.forename: Yu
authors.initials: Y
authors.lastname: Guo
authors.affiliation: Division of Vascular Surgery, New York University Langone Medical Center, New York, NY.
authors.forename: Thomas
authors.initials: T
authors.lastname: Maldonado
authors.affiliation: Division of Vascular Surgery, New York University Langone Medical Center, New York, NY.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Adelman
authors.affiliation: Division of Vascular Surgery, New York University Langone Medical Center, New York, NY; Division of Population Health, New York University Langone Medical Center, New York, NY; Divison of Cardiology, New York University Langone Medical Center, New York, NY.
authors.forename: Jeffery S
authors.initials: JS
authors.lastname: Berger
authors.affiliation: Division of Vascular Surgery, New York University Langone Medical Center, New York, NY. Electronic address: Caron.Rockman@nyumc.org.
authors.forename: Caron B
authors.initials: CB
authors.lastname: Rockman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000413:Alaska / Q000453:epidemiology; D000072957:Alaska Natives; D055109:Ankle Brachial Index; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000208:ethnology*; D015995:Prevalence; D012307:Risk Factors; D012720:Severity of Illness Index; D044465:White People