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CLINICAL RESEARCH: PERIPHERAL VASCULAR DISEASE

Novel Cardiovascular Risk Factors Do Not Completely Explain the Higher Prevalence of Peripheral Arterial Disease Among African Americans

The San Diego Population Study

Joachim H. Ix, MD, MAS^_*,,,_*, Matthew A. Allison, MD, MPH, Julie O. Denenberg, MA, Mary Cushman, MD and Michael H. Criqui, MD, MPH^_*,

^_* Department of Medicine, University of California, San Diego, San Diego, California
Division of Nephrology, University of California, San Diego, San Diego, California
Department of Family and Preventive Medicine, University of California, San Diego, San Diego, California
Department of Medicine, University of Vermont College of Medicine, Burlington, Vermont.

Manuscript received January 9, 2008; revised manuscript received February 15, 2008, accepted March 17, 2008.

^_* Reprint requests and correspondence: Dr. Joachim H. Ix, Division of Nephrology-Hypertension, Department of Medicine, University of California, San Diego, and Veterans Affairs San Diego Healthcare System, 3350 La Jolla Village Drive, Mail Code 111-H, San Diego, California 92161. (Email: joeix{at}hotmail.com).

Objectives: This study was designed to determine whether novel cardiovascular disease (CVD) risk factors explain the high prevalence of peripheral arterial disease (PAD) among African Americans.

Background: Compared with Caucasians, African Americans have higher prevalence of PAD, an association that is not explained by traditional CVD risk factors. The degree to which novel CVD risk markers may explain the higher prevalence is uncertain.

Methods: A nested case-control study within the San Diego Population Study was performed. The study evaluated 104 persons with PAD and 164 age- and gender-matched control subjects who were employees of a large public university and participated in a peripheral artery and venous disease study. Nine novel CVD risk factors (homocysteine, lipoprotein (a), C-reactive protein, fibrinogen, tumor necrosis factor-alpha, von Willebrand factor, prothrombin fragment 1-2, D-dimer, and plasmin antiplasmin) were measured. Multivariable logistic regression evaluated whether these novel factors attenuated the association of African-American race and PAD and whether there was differential ethnic susceptibility to the novel factors.

Results: African Americans had 3-fold higher odds of PAD in age- and gender-matched models (odds ratio [OR] 3.1; 95% confidence interval [CI] 1.5 to 6.4; p < 0.01), an association that was modestly attenuated by adjustment for traditional (OR 2.4; 95% CI 0.9 to 6.1; p = 0.06) and novel CVD risk markers (OR 1.9; 95% CI 0.7 to 4.7; p = 0.18). Among the novel factors, the attenuation was primarily due to fibrinogen and lipoprotein (a). No interactions by novel CVD risk markers (both p values for interaction 0.24) were observed.

Conclusions: Traditional and novel CVD risk factors only partially explain the higher prevalence of PAD among African Americans.

Abbreviations and Acronyms   ABI = ankle-brachial index   BMI = body mass index   CVD = cardiovascular disease   CV = coefficient of variation   ELISA = enzyme-linked immunosorbent assay   PAD = peripheral arterial disease   SBP = systolic blood pressure   WHR = waist/hip ratio

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