Clinical Investigations: Acute Ischemic Heart Disease
Prevalence and clinical correlates of peripheral arterial disease in the Framingham Offspring Study,☆☆

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Abstract

Background Peripheral arterial disease (PAD) is associated with an increased risk for mortality. We sought to assess the prevalence of PAD and its risk factors in a population-based sample. Methods We examined 1554 males and 1759 females with a mean age of 59 years who attended a Framingham Offspring Study examination from 1995 to 1998. PAD was defined by an ankle-brachial blood pressure index of <0.9. Age- and sex-adjusted and multivariable logistic regression analyses were performed to identify factors associated with PAD. Results The prevalences of PAD, current intermittent claudication, lower extremity bruits and surgical intervention were 3.9%, 1.9%, 2.4% and 1.4% in males and 3.3%, 0.8%, 2.3% and 0.5% in females. Hypercholesterolemia, high-density lipoprotein cholesterol, triglyceride, diabetes, hypertension, current smoking, pack-years of smoking, body mass index, fibrinogen, and prevalent coronary disease were associated with PAD in age- and sex-adjusted analyses. Odds ratios and 95% CIs for significant associations identified from multivariable analyses are as follows: each 10 years of age, 2.6 (2.0, 3.4); hypertension, 2.2 (1.4, 3.5); smoking, 2.0 (1.1, 3.4); 10 pack-years of smoking, 1.3 (1.2, 1.4); 50 mg/dL of fibrinogen, 1.2 (1.1, 1.4); 5 mg/dL of high-density lipoprotein, 0.9 (0.8, 1.0); coronary disease, 2.6 (1.6, 4.1). Conclusions Smoking cessation and hypertension control are important goals in the aim to reduce PAD and its associated impact on quality of life, functional decline, and risk for subsequent cardiovascular disease. (Am Heart J 2002;143:961-5.)

Section snippets

Methods

Children of the original cohort of the Framingham Heart Study and their spouses were recruited in 1971 to form the Framingham Offspring Study cohort. The 5124 Offspring participants have been examined approximately every 4 years since the study's inception. All participants aged ≥40 years who attended the 6th Offspring cycle examination from 1995 to 1998 were eligible for inclusion in this study. Informed consent was obtained from study participants at the time of their examination. The

Results

Among the 1554 males and 1759 females included in this sample, 3.6% had an abnormal ABI of <0.9, 7.1% had a borderline ABI of 0.9 to 1.0, and 89.3% had a normal ABI of >1.0. The prevalence of current intermittent claudication was 1.9% in males and 0.8% in females (Table I).

. Prevalence of different manifestations of peripheral arterial disease

ManifestationMales (n = 1554)Females (n = 1759)
Ankle-brachial index < 0.9 (%)3.93.3
Current intermittent claudication (%)1.90.8
Lower extremity bruit (%)2.42.3

Discussion

In our unselected sample of middle-aged Framingham males and females, the prevalence of PAD, as determined by ABI, was 3% to 4%. The Atherosclerosis Risk In Communities (ARIC) study and 2 reports of middle-aged population samples derived from countries outside the United States found the prevalence of PAD to be similar to that observed in our sample.19, 20, 21 The prevalence of PAD was lower in our sample than some other population-based reports; in part a result of differences in the age

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    Reprint requests: Joanne M. Murabito, MD, MSc, The Framingham Heart Study, 73 Mount Wayte Ave, Suite 2, Framingham, MA 01702-5827.

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    E-mail: [email protected]

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