Johns Hopkins University, Baltimore, MD, USA.
Albert Einstein College of Medicine, The Bronx, NY, USA.
Atherosclerosis. 2022 Apr;347:55-62. doi: 10.1016/j.atherosclerosis.2022.03.008. Epub 2022 Mar 14.
Peripheral artery disease (PAD) and lower levels of physical activity are both associated with higher mortality. Yet, their joint prognostic impact has not been systematically examined, especially in Hispanics/Latinos, and with objective measures. We aimed to examine the joint associations of PAD and physical activity with mortality in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL).
We studied 7,620 Hispanic/Latino adults aged 45-74 years at baseline (2008-2011) who underwent assessment of PAD with ankle-brachial index (ABI) and physical activity with hip-worn accelerometry. We calculated four physical activity measures: sedentary time, light activity, moderate/vigorous activity, and total activity counts. We quantified the relationship between ABI and mortality overall, and by tertiles of activity measures in restricted cubic splines, using multivariable Cox models accounting for sampling weights. We also assessed cross-categories of ABI and activity measures with mortality.
During a median follow up of 7.1 years, 314 participants died. We observed a U-shaped association of ABI with mortality overall (e.g., hazard ratio 1.80 [95%CI 1.20-2.80] at ABI 0.7 vs 1.2). This U-shaped association was generally consistent after stratifying by activity measures, but an elevated mortality risk for higher ABI was not evident in the most active tertile based on sedentary time, time in light activity, and total activity counts. In the cross-category analysis of ABI and physical activity, the highest mortality risk was consistently seen in abnormal ABI (≤0.9 or >1.4) plus the least active tertile (e.g., HR 5.61 [3.31-9.51] for light activity), compared to referent ABI (0.9-1.4) plus the other more active two tertiles, with no interactions between ABI and activity measure.
Abnormal ABI and lower accelerometry-based physical activity were independently and jointly associated with mortality in Hispanics, suggesting the importance of simultaneously evaluating leg vascular condition and physical activity.
外周动脉疾病（PAD）和较低水平的体力活动均与更高的死亡率相关。然而，它们的联合预后影响尚未得到系统研究，特别是在西班牙裔/拉丁裔人群中，且没有使用客观测量指标。我们旨在检查 HCHS/SOL 研究中 PAD 与体力活动联合与死亡率的关系。
我们研究了 7620 名年龄在 45-74 岁之间的西班牙裔/拉丁裔成年人，他们在基线时接受了踝臂指数（ABI）评估以检测 PAD，并通过佩戴在髋部的加速度计来评估体力活动。我们计算了四项体力活动指标：久坐时间、轻度活动、中度/剧烈活动和总活动计数。我们使用多变量 Cox 模型，根据受限立方样条分析，在考虑了抽样权重的情况下，计算了 ABI 与死亡率之间的总体关系，以及按活动指标三分位数的关系。我们还评估了 ABI 和体力活动指标的交叉类别与死亡率之间的关系。
在中位随访 7.1 年期间，有 314 名参与者死亡。我们观察到 ABI 与死亡率之间呈 U 型关联（例如，ABI 为 0.7 时的危险比为 1.80[95%CI 1.20-2.80]）。这种 U 型关联在按活动指标分层后基本一致，但在基于久坐时间、轻度活动时间和总活动计数的最活跃三分位数中，ABI 较高并不意味着死亡率风险增加。在 ABI 和体力活动的交叉类别分析中，异常 ABI（≤0.9 或>1.4）和最不活跃的三分位数（例如，轻活动时的 HR 为 5.61[3.31-9.51]）的最高死亡率风险始终存在，与参考 ABI（0.9-1.4）和其他更活跃的两个三分位数相比，ABI 与活动测量之间没有交互作用。
异常 ABI 和基于加速度计的较低体力活动与西班牙裔人群的死亡率独立且共同相关，这表明同时评估腿部血管状况和体力活动的重要性。
