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Peripheral artery disease and cardiovascular risk factors in the elderly. The Honolulu Heart Program
J D Curb1, K Masaki, B L Rodriguez
1Division of Clinical Epidemiology, John A Burns School of Medicine, University of Hawaii at Manoa, USA. curb@hhs.cba.hawaii.edu
Insights
Peripheral vascular disease, indicated by ankle-brachial index (ABI), is linked to higher mortality. Risk factors like hypertension and smoking significantly predict abnormal ABI in elderly Japanese American men.
Area of Science:
- Gerontology
- Cardiovascular Medicine
- Epidemiology
Background:
- Peripheral vascular disease, assessed via ankle-brachial index (ABI), correlates with increased mortality and morbidity.
- Limited data exists on risk factors for ABI in the elderly, particularly those over 80 and minority populations.
Purpose of the Study:
- To investigate the relationship between risk factors and ABI in elderly Japanese American men.
- To determine the prevalence and predictors of abnormal ABI in this demographic.
Main Methods:
- Utilized data from the Honolulu Heart Program's fourth reexamination of 3450 ambulatory elderly Japanese American men.
- Measured ABI and various risk factors (cholesterol, glucose, alcohol, hypertension, smoking) at baseline and assessed ABI 25 years later.
Main Results:
- Prevalence of abnormal ABI (< 0.9) was 13.6%, increasing with age (8.0% in 71-74 years to 27.4% in 85-93 years).
- U-shaped associations were observed for several risk factors.
- Baseline risk factors predicted abnormal ABI 25 years later; odds ratios were significant for hypertension (1.8) and smoking (2.9).
Conclusions:
- ABI is a marker for generalized atherosclerotic disease in elderly Japanese American men.
- Risk factors like hypertension and smoking are significant predictors of abnormal ABI in this population.
- Findings highlight the importance of managing vascular risk factors in aging populations.
Abstract:
Peripheral vascular disease as measured by the ankle/brachial blood pressure index (ABI) is associated with increased risk of mortality and morbidity. Few sources of data on the relationship of risk factors to ABI are available for the elderly, especially those > 80 years of age, and minority populations. ABI measurements from the Honolulu Heart Program's fourth reexamination of 3450 ambulatory, elderly Japanese American men indicate that the prevalence of an abnormal ABI, defined as a ratio of < 0.9, was 13.6%, increasing from 8.0% in those 71 to 74 years of age to 27.4% in those 85 to 93 years. Associations that were U or J shaped were present for a number or risk factors (higher rates of abnormality [ABI < 0.9] in those in the lowest and highest risk factor quintiles) in a cross-sectional analysis. Risk factors measured at baseline were also predictive of an abnormal ABI 25 years later, even after adjustment for multiple risk factors. The odds ratio (OR) for an ABI < 0.9 at the 80th percentile of cholesterol compared with that at the 20th percentile was 1.4; the OR for 1-hour postload glucose was 1.3, and for alcohol intake 1.2. The OR associated with hypertension was 1.8 and that for smoking, 2.9 (P < .05 for all ORs). These findings are consistent with ABI being a marker for generalized atherosclerotic disease in old and very old Japanese American men.