CLINICAL RESEARCH: RISK FOR CARDIOVASCULAR DISEASE
The Effect of Novel Cardiovascular Risk Factors on the Ethnic-Specific Odds for Peripheral Arterial Disease in the Multi-Ethnic Study of Atherosclerosis (MESA)
Matthew A. Allison, MD, MPH*,*,
Michael H. Criqui, MD, MPH*,
Robyn L. McClelland, PhD ,
JoAnn M. Scott, MS,
Mary M. McDermott, MD ,
Kiang Liu, PhD,
Aaron R. Folsom, MD ,
Alain G. Bertoni, MD||,
A. Richey Sharrett, MD, DrPH¶,
Shunichi Homma, MD# and
Sujata Kori, MD**
* University of California San Diego, San Diego, California
University of Washington, Seattle, Washington
Northwestern University, Chicago, Illinois
University of Minnesota, Minneapolis/St. Paul, Minnesota
|| Wake Forest University, Winston-Salem, North Carolina
¶ Johns Hopkins University, Baltimore, Maryland
# Columbia University, New York, New York
** Cardiology Consultants of Orange County, Anaheim, California
Manuscript received February 6, 2006;
revised manuscript received May 3, 2006,
accepted May 9, 2006.
* Reprint requests and correspondence: Dr. Matthew A. Allison, University of California San Diego, Department of Family and Preventive Medicine, 3855 Health Sciences Drive, MC 0817, La Jolla, California 92093-0817. (Email: mallison{at}ucsd.edu).
OBJECTIVES: The purpose of this study was to: 1) determine the significance and magnitude of associations between novel cardiovascular disease (CVD) risk factors and peripheral arterial disease (PAD) after adjustment for traditional risk factors; and 2) ascertain the extent to which novel risk factors explain the excess or lower risk for PAD in different ethnic groups.
BACKGROUND: Previous reports have found a significant difference in the risk of PAD by ethnic group, with some of the risk difference attributed to different levels of traditional CVD risk factors.
METHODS: A total of 6,814 individuals free of clinically apparent CVD were enrolled in the MESA (Multiethnic Study of Atherosclerosis) and underwent standardized testing for the presence of PAD by the ankle-brachial index. These subjects also had fasting blood drawn for serum cholesterol, glucose, and a number of novel biomarkers for CVD. Non-Hispanic whites were the largest ethnic group (38%), followed by African Americans (28%), Hispanics (22%), and Chinese (12%).
RESULTS: In this cross-sectional analysis, 6,653 subjects with an ankle brachial index <1.40 were analyzed. The mean (SD) age was 62.2 (10.2) years, and 52.9% were women. Interleukin-6, fibrinogen, D-dimer, and homocysteine were significantly associated with PAD after adjustment for traditional CVD risk factors. Compared with non-Hispanic whites and after adjustment for traditional and "novel" risk factors, the odds for PAD were 1.47 (95% confidence interval [CI]: 1.07 to 2.02) times higher in African Americans, while being 0.45 (95% CI: 0.29 to 0.70) and 0.44 (95% CI: 0.24 to 0.78) in Hispanics and Chinese, respectively.
CONCLUSIONS: Ethnic associations with PAD remained significant even after adjustment for traditional and novel risk factors. This suggests that unknown factors may account for the residual ethnic differences in PAD.
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Abbreviations and Acronyms
| | ABI = ankle brachial index | | AUC = area under the curve | | BMI = body mass index | | CHD = coronary heart disease | | CI = confidence interval | | CVD = cardiovascular disease | | DP = dorsalis pedis | | HDL = high-density lipoprotein | | LDL = low-density lipoprotein | | MESA = Multi-Ethnic Study of Atherosclerosis | | NHANES = National Health and Nutrition Examination Survey | | OR = odds ratio | | PAD = peripheral arterial disease | | PT = posterior tibial | | ROC = receiver-operator characteristic | | SBP = systolic blood pressure |
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