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.
|
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 |
|
This article has been cited by other articles:
|
|
|
|
 
P.C. Bennett, S. Silverman, P.S. Gill, and G.Y.H. Lip
Ethnicity and peripheral artery disease
QJM,
January 1, 2009;
102(1):
3 - 16.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. P Reis, E. D Michos, D. von Muhlen, and E. R Miller III
Differences in vitamin D status as a possible contributor to the racial disparity in peripheral arterial disease
Am. J. Clinical Nutrition,
December 1, 2008;
88(6):
1469 - 1477.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. M. Steffen, D. A. Duprez, J. L. Boucher, A. G. Ershow, and A. T. Hirsch
Management of Peripheral Arterial Disease
Diabetes Spectr,
July 1, 2008;
21(3):
171 - 177.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. H. Ix, M. A. Allison, J. O. Denenberg, M. Cushman, and M. H. Criqui
Novel cardiovascular risk factors do not completely explain the higher prevalence of peripheral arterial disease among African Americans. The San Diego Population Study.
J. Am. Coll. Cardiol.,
June 17, 2008;
51(24):
2347 - 2354.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. A. Allison, W. R. Hiatt, A. T. Hirsch, J. R. Coll, and M. H. Criqui
A High Ankle-Brachial Index Is Associated With Increased Cardiovascular Disease Morbidity and Lower Quality of Life
J. Am. Coll. Cardiol.,
April 1, 2008;
51(13):
1292 - 1298.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. M. Reich, G. Heiss, L. L. Boland, A. T. Hirsch, K. Wu, and A. R. Folsom
Ankle brachial index and hemostatic markers in the Atherosclerosis Risk in Communities (ARIC) study cohort
Vascular Medicine,
November 1, 2007;
12(4):
267 - 273.
[Abstract]
[PDF]
|
|
|
|
|
|
|
H.R.S. Girn, N.M. Orsi, and S. Homer-Vanniasinkam
An overview of cytokine interactions in atherosclerosis and implications for peripheral arterial disease
Vascular Medicine,
November 1, 2007;
12(4):
299 - 309.
[Abstract]
[PDF]
|
|
|
|
|
|
|
J. W. Knowles, T. L. Assimes, J. Li, T. Quertermous, and J. P. Cooke
Genetic Susceptibility to Peripheral Arterial Disease: A Dark Corner in Vascular Biology
Arterioscler. Thromb. Vasc. Biol.,
October 1, 2007;
27(10):
2068 - 2078.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
