Allison Matthew A, Criqui Michael H, McClelland Robyn L, Scott JoAnn M, McDermott Mary M, Liu Kiang, Folsom Aaron R, Bertoni Alain G, Sharrett A Richey, Homma Shunichi, Kori Sujata
University of California San Diego, San Diego, California, USA.
J Am Coll Cardiol. 2006 Sep 19;48(6):1190-7. doi: 10.1016/j.jacc.2006.05.049. Epub 2006 Aug 28.
The purpose of this study was to: 1) determine the significance and magnitude of associations between novel cardiovascular disease (CVD) risk factors and peripheral arterial disease (PAD) after adjustment for traditional risk factors; and 2) ascertain the extent to which novel risk factors explain the excess or lower risk for PAD in different ethnic groups.
Previous reports have found a significant difference in the risk of PAD by ethnic group, with some of the risk difference attributed to different levels of traditional CVD risk factors.
A total of 6,814 individuals free of clinically apparent CVD were enrolled in the MESA (Multiethnic Study of Atherosclerosis) and underwent standardized testing for the presence of PAD by the ankle-brachial index. These subjects also had fasting blood drawn for serum cholesterol, glucose, and a number of novel biomarkers for CVD. Non-Hispanic whites were the largest ethnic group (38%), followed by African Americans (28%), Hispanics (22%), and Chinese (12%).
In this cross-sectional analysis, 6,653 subjects with an ankle brachial index <1.40 were analyzed. The mean (SD) age was 62.2 (10.2) years, and 52.9% were women. Interleukin-6, fibrinogen, D-dimer, and homocysteine were significantly associated with PAD after adjustment for traditional CVD risk factors. Compared with non-Hispanic whites and after adjustment for traditional and "novel" risk factors, the odds for PAD were 1.47 (95% confidence interval [CI]: 1.07 to 2.02) times higher in African Americans, while being 0.45 (95% CI: 0.29 to 0.70) and 0.44 (95% CI: 0.24 to 0.78) in Hispanics and Chinese, respectively.
Ethnic associations with PAD remained significant even after adjustment for traditional and novel risk factors. This suggests that unknown factors may account for the residual ethnic differences in PAD.
本研究的目的是：1）在对传统危险因素进行调整后，确定新型心血管疾病（CVD）危险因素与外周动脉疾病（PAD）之间关联的显著性和程度；2）确定新型危险因素在多大程度上解释了不同种族人群中PAD的额外风险或较低风险。
先前的报告发现不同种族人群患PAD的风险存在显著差异，部分风险差异归因于传统CVD危险因素的不同水平。
共有6814名无临床明显CVD的个体纳入动脉粥样硬化多族裔研究（MESA），并通过踝臂指数进行PAD存在情况的标准化检测。这些受试者还进行了空腹采血，以检测血清胆固醇、葡萄糖以及一些新型CVD生物标志物。非西班牙裔白人是最大的种族群体（38%），其次是非洲裔美国人（28%）、西班牙裔（22%）和华裔（12%）。
在这项横断面分析中，对6653名踝臂指数<1.40的受试者进行了分析。平均（标准差）年龄为62.2（10.2）岁，52.9%为女性。在对传统CVD危险因素进行调整后，白细胞介素-6、纤维蛋白原、D-二聚体和同型半胱氨酸与PAD显著相关。与非西班牙裔白人相比，在对传统和“新型”危险因素进行调整后，非洲裔美国人患PAD的几率高1.47倍（95%置信区间[CI]：1.07至2.02），而西班牙裔和华裔分别为0.45（95%CI：0.29至0.70）和0.44（95%CI：0.24至0.78）。
即使在对传统和新型危险因素进行调整后，种族与PAD之间的关联仍然显著。这表明未知因素可能是PAD中种族差异的原因。
