Prevalence of peripheral artery disease varies significantly depending upon the method of calculating ankle brachial index. Reed James F,Eid Sherrine,Edris Bree,Sumner Andrew D European journal of cardiovascular prevention and rehabilitation : official journal of the European Society of Cardiology, Working Groups on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology OBJECTIVE:Peripheral artery disease (PAD) identifies individuals at high risk for future cardiovascular disease (CVD) warranting aggressive risk reduction therapies. PAD can be diagnosed noninvasively by calculating the ankle brachial index (ABI), a ratio of ankle and arm blood pressures. We examined the existing various methods of calculating ABI and the resulting estimates of PAD prevalence. METHODS:We analyzed data from three National Health and Nutrition Examination Surveys. PAD prevalence using three different methods of calculating ABI was determined in 5,376 participants, aged > or =40 years without prior history of CVD. ABI was defined as an ankle brachial index of less than 0.9. Statistical analysis was performed using SPSS V15.0. RESULTS:PAD prevalence among asymptomatic adults without CVD increased significantly during the 6-year time period (1999-2004), regardless of the method used for determining ABI. However, across the National Health and Nutrition Examination Survey assessments, ABI method significantly affected calculated PAD prevalence. Differences in calculated PAD prevalence correspond to approximately 2.2 million persons who would be reclassified as having or not having PAD. CONCLUSION:The calculated prevalence of asymptomatic PAD varies significantly by the ABI method used. Further study is required to determine the most accurate method of performing ABI. 10.1097/HJR.0b013e32832955e2

Risk factors for premature peripheral vascular disease: results for the National Health and Nutritional Survey, 1999-2002. Lane John S,Vittinghoff Eric,Lane Karen T,Hiramoto Jade S,Messina Louis M Journal of vascular surgery PURPOSE:Premature peripheral vascular disease (PVD), occurring <60 years of age, is associated with significant cardiovascular morbidity, limb loss, and death. We hypothesized that different risk factors predict the development of PVD in patients <60 years than in patients > or =60 years. METHODS:To address this question, we conducted a population-based observational study using the National Health and Nutritional Survey (NHANES) data set, which represents the noninstitutionalized civilian population in the United States. From 1999 to 2002, 5083 participants were analyzed as part of the NHANES survey. PVD status was defined by an ankle-brachial index (ABI) of <0.9. Putative risk factors for the development of PVD were collected by physical examination, interview, and laboratory testing. Univariate and multivariate logistic regression analyses were used to evaluate interactions between age strata and the development of PVD. RESULTS:Premature PVD was found in 2.1% +/- 0.2% of the population <60 years, and PVD was found in 12.0% +/- 0.8% of the population > or =60 years. This corresponds to approximately 1.44 million people with premature PVD. Multivariate analysis determined coronary artery disease (odds ratio [OR] 2.90 vs 1.26, P = .083) and elevated serum fibrinogen (OR 1.07 vs 1.03, P = .034) were stronger predictors of PVD in subjects <60 years than in older subjects. Chronic renal insufficiency (OR 1.02 vs 1.16, P = .006) was more highly predictive of PVD in subjects >60 years. Other significant predictors, irrespective of age, in the multivariate model included hypertension (OR 1.99, P < .001), smoking (OR 2.22, P < .001), and serum homocysteine (OR 1.27, P = .067). CONCLUSIONS:Clinicians should be aware of the high risk of developing premature PVD in patients <60 years with coexisting coronary artery disease or elevated plasma fibrinogen. Routine screening by ABI measurements in high-risk patients would enhance the detection of subclinical premature PVD and allow for secondary intervention. 10.1016/j.jvs.2006.04.015

Control of risk factors among people with diagnosed diabetes, by lower extremity disease status. Dorsey Rashida R,Eberhardt Mark S,Gregg Edward W,Geiss Linda S Preventing chronic disease INTRODUCTION:We examined the control of modifiable risk factors among a national sample of diabetic people with and without lower extremity disease (LED). METHODS:The sample from the 1999-2004 National Health and Nutrition Examination Survey consisted of 948 adults aged 40 years or older with diagnosed diabetes and who had been assessed for LED. LED was defined as peripheral arterial disease (ankle-brachial index <0.9), peripheral neuropathy (> or = 1 insensate area), or presence of foot ulcer. Good control of modifiable risk factors, based on American Diabetes Association recommendations, included being a nonsmoker and having the following measurements: hemoglobin A1c (HbA1c) less than 7%, systolic blood pressure less than or equal to 130 mm Hg, diastolic blood pressure less than or equal to 80 mm Hg, high-density lipoprotein (HDL) cholesterol greater than 50 mg/dL, and body mass index (BMI) between 18.5 kg/m(2) and 24.9 kg/m(2). RESULTS:Diabetic people with LED were less likely than were people without LED to have recommended levels of HbA1c (39.3% vs 53.5%) and HDL cholesterol (29.7% vs 41.1%), but there were no differences in systolic or diastolic blood pressure, BMI classification, or smoking status between people with and without LED. Control of some risk factors differed among population subgroups. Notably, among diabetic people with LED, non-Hispanic blacks were more likely to have improper control of HbA1c (adjusted odds ratio [AOR] = 2.0; 95% confidence interval [CI], 1.1-3.9), systolic blood pressure (AOR = 1.9; 95% CI, 1.1-3.2), and diastolic blood pressure (AOR = 2.6; 95% CI, 1.1-5.8), compared with non-Hispanic whites. CONCLUSION:Control of 2 of 6 modifiable risk factors was worse in diabetic adults with LED compared with diabetic adults without LED. Among diabetic people with LED, non-Hispanic blacks had worse control of 3 of 6 risk factors compared with non-Hispanic whites.

Differences in vitamin D status as a possible contributor to the racial disparity in peripheral arterial disease. The American journal of clinical nutrition BACKGROUND:Racial differences in cardiovascular risk factors do not fully explain the higher prevalence of lower-extremity peripheral arterial disease (PAD) in black adults. OBJECTIVE:We sought to determine whether any of this excess risk may be explained by vitamin D status, which has been widely documented to be lower in blacks than in whites. DESIGN:This population-based cross-sectional study included 2987 white and 866 black persons aged >or=40 y from the 2001-2004 National Health and Nutrition Examination Survey. PAD was defined as an ankle-brachial pressure index of <0.90 in either leg. RESULTS:Mean (+/-SEM) 25-hydroxyvitamin D [25(OH)D] concentrations were significantly lower in black than in white adults (39.2 +/- 1.0 and 63.7 +/- 1.1 nmol/L, respectively; P < 0.001). Adjusted odds ratios for PAD decreased in a dose-dependent fashion with increasing quartiles of 25(OH)D in white adults [1.00 (referent), 0.86, 0.67, and 0.53; P for trend < 0.001]. In black adults, the association was nonlinear; models with cubic splines suggested evidence of greater odds for PAD and a trend for lower odds for PAD at the lowest and highest concentrations of 25(OH)D, respectively. After adjustment for racial differences in socioeconomic status and for traditional and novel risk factors, odds for PAD in black compared with white adults were reduced from 2.11 (95% CI: 1.55, 2.87) to 1.67 (1.11, 2.51). After additional adjustment for 25(OH)D, the odds were further reduced to 1.33 (0.84, 2.10). CONCLUSIONS:Racial differences in vitamin D status may explain nearly one-third of the excess risk of PAD in black compared with white adults. Additional research is needed to confirm these findings. 10.3945/ajcn.2008.26447

Inter-leg systolic blood pressure difference has been associated with all-cause and cardiovascular mortality: analysis of NHANES 1999-2004. BMC public health BACKGROUND:Inter-leg systolic blood pressure difference (ILSBPD) has emerged as a novel cardiovascular risk factor. This study aims to investigate the predictive value of ILSBPD on all-cause and cardiovascular mortality in general population. METHODS:We combined three cycles (1999-2004) of the National Health and Nutrition Examination Survey (NHANES) data. Levels of ILSBPD were calculated and divided into four groups based on three cut-off values of 5, 10 and 15mmHg. Time-to-event curves were estimated with the use of the Kaplan-Meier method, and two multivariable Cox proportional hazards regression models were conducted to assess the hazard ratios (HRs) and 95% confidence intervals (CIs) of all-cause and cardiovascular mortality associated with ILSBPD. RESULTS:A total of 6 842 subjects were included, with the mean (SD) age of 59.5 (12.8) years. By December 31, 2019, 2 544 and 648 participants were identified all-cause and cardiovascular mortality respectively during a median follow-up of 16.6 years. Time-to-event analyses suggested that higher ILSBPD was associated with increased all-cause and cardiovascular mortality (logrank, p < 0.001). Every 5mmHg increment of ILSBPD brings about 5% and 7% increased risk of all-cause and cardiovascular mortality, and individuals with an ILSBPD ≥ 15mmHg were significantly associated with higher incidence of all-cause mortality (HR 1.43, 95%CI 1.18-1.52, p < 0.001) and cardiovascular mortality (HR 1.73, 95%CI 1.36-2.20, p < 0.001) when multiple confounding factors were adjusted. Subgroup and sensitivity analysis confirmed the relationship. CONCLUSIONS:Our findings suggest that the increment of ILSBPD was significantly associated with higher risk of all-cause and cardiovascular mortality in general population. 10.1186/s12889-024-18508-8