title: Risk factors of peripheral arterial disease: a case control study in Sri Lanka.
abstract: BACKGROUND
  Peripheral artery disease (PAD) is an important global health problem and contributes to notable proportion of morbidity and mortality. This particular manifestation of systemic atherosclerosis is largely under diagnosed and undertreated. For sustainable preventive strategies in a country, it is mandatory to identify country-specific risk factors. We intended to assess the risk factors of PAD among adults aged 40-74 years.
  
  
  METHODS
  This case control study was conducted in 2012-2013 in Sri Lanka. Seventy-nine cases and 158 controls in the age group of 40-74 years were selected for the study in order to have case to control ratio 1:2. The criterion for selecting cases and control was based on Ankle brachial pressure index (ABPI). Cases were selected from those who had ABPI 0.85 or less (ABPI ≤0.85) in either lower limb. Controls were selected from those ABPI score between 1.18 and 1.28 in both lower limbs. Only newly identified individuals with PAD were selected as cases. Controls were selected from the same geographical location and within the 5 year age group as cases.
  
  
  RESULTS
  The history of diabetes mellitus more than 10 years (OR 5.8, 95% CI 2.2-14.2), history of dyslipidemia for more than 10 years (OR 4.9, 95% CI 2.1-16.2), history of hypertension for more than 10 years (OR 3.8, 95% CI 1.8-12.7) and smoking (OR 2.9, 95% CI 1.2-6.9), elevated HsCRP (OR 3.7, 95% CI 1.2-12.0) and hyperhomocysteinemia (OR 3.0, 95% CI 1.1-8.1) were revealed as country specific significant risk factor of PAD.
  
  
  CONCLUSIONS
  Diabetes mellitus, hypertension, dyslipidemia, smoking as well as elevated homocysteine and HsCRP found as risk factors of PAD. Longer the duration or higher level exposure to these risk factors has increased the risk of PAD. These findings emphasis the need for routine screening of PAD among patients with the identified risk factors.
authors.affiliation: Ministry of Health, Baddegama wimalawansa Mawatha, Colombo 10, Sri Lanka. Janaka.weragoda@gmail.com.|Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, USA. Janaka.weragoda@gmail.com.
authors.forename: Janaka
authors.initials: J
authors.lastname: Weragoda
authors.affiliation: Department of Community Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.|Paraclinical Department, Faculty of Medicine, General Sir John Kotelawala Defense University, Ratmalana, Sri Lanka.
authors.forename: Rohini
authors.initials: R
authors.lastname: Seneviratne
authors.affiliation: Department of Community Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
authors.forename: Manuj C
authors.initials: MC
authors.lastname: Weerasinghe
authors.affiliation: Department of Surgery, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
authors.forename: S M
authors.initials: SM
authors.lastname: Wijeyaratne
mesh_terms: D000328:Adult; D000368:Aged; D055109:Ankle Brachial Index; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D048909:Diabetes Complications / Q000453:epidemiology; D050171:Dyslipidemias / Q000453:epidemiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000453:epidemiology*; D015995:Prevalence; D016016:Proportional Hazards Models; D012044:Regression Analysis; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D013188:Sri Lanka; D011795:Surveys and Questionnaires
keywords: Case control study; Peripheral arterial disease; Risk factors; Sri Lanka