doi: 10.1161/CIRCULATIONAHA.105.546507
(Circulation. 2005;112:2703-2707.)
© 2005 American Heart Association, Inc.
Vascular Medicine |
Ethnicity and Peripheral Arterial Disease
The San Diego Population Study
From the Department of Family and Preventive Medicine (M.H.C., V.V., J.O.D., E.H., M.A., R.D.L., A.G., W.P.B.), Department of Medicine (M.H.C.), and Department of Surgery (W.P.B., A.F.), School of Medicine, University of California, San Diego, La Jolla, Calif.
Correspondence to Michael H. Criqui, MD, MPH, 9500 Gilman Dr, 352 SCRB, La Jolla, CA 92093-0607. E-mail mcriqui{at}ucsd.edu
Received March 1, 2005; revision received July 15, 2005; accepted July 19, 2005.
Background— Previous studies have indicated higher rates of peripheral arterial disease (PAD) in blacks than in non-Hispanic whites (NHWs), with limited information available for Hispanics and Asians. The reason for the PAD excess in blacks is unclear.
Methods and Results— Ethnic-specific PAD prevalence rates were determined in a randomly selected defined population that included 4 ethnic groups; NHWs, blacks, Hispanics, and Asians. A total of 2343 participants aged 29 to 91 years were evaluated. There were 104 cases of PAD (4.4%). In weighted logistic models with NHWs as the reference group and containing demographic factors only, blacks had a higher PAD prevalence than NHWs (OR=2.30, P<0.024), whereas PAD rates in Hispanics and Asians, although somewhat lower, were not significantly different from NHWs. Blacks had significantly more diabetes and hypertension than NHWs and a significantly higher body mass index. Inclusion of these variables and other PAD risk factors in the model did not change the effect size for black ethnicity (OR=2.34, P=0.048). A model containing interaction terms for black ethnicity and each of the other risk factors revealed no significant interaction terms, which indicates no evidence that blacks were more "susceptible" than NHWs to cardiovascular disease risk factors.
Conclusions— Black ethnicity was a strong and independent risk factor for PAD, which was not explained by higher levels of diabetes, hypertension, and body mass index. There was no evidence of a greater susceptibility of blacks to cardiovascular disease risk factors as a reason for their higher PAD prevalence. Thus, the excess risk of PAD in blacks remains unexplained and requires further study.
Key Words: ankle-brachial index • epidemiology • ethnicity • risk factors • peripheral vascular disease
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