Department of Clinical Sciences, Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Barbados.
Equity Research and Innovation Center, Yale School of Medicine, New Haven, Connecticut, United States of America.
PLoS One. 2024 Aug 26;19(8):e0306918. doi: 10.1371/journal.pone.0306918. eCollection 2024.
Peripheral arterial disease (PAD) indicates generalised atherosclerotic disease but is often asymptomatic. The prevalence and potential risk factors of PAD were studied in ECHORN cohort study participants.
Representative samples of community-dwelling people ≥40 years of age residing in Barbados, Puerto Rico, Trinidad, and the USVI were recruited. The survey included questions on diabetes, hypertension, heart disease and smoking status. Body Mass Index, HbA1c, blood glucose and lipids were determined. Ankle brachial index (ABI) was evaluated in one leg. An oscillometric device measured arm and leg systolic BP simultaneously. ABI classifications were PAD ≤0.90, borderline 0.91 to 0.99, normal 1.00 to 1.40, and non-compressible >0.40. Multivariable logistic regression tested associations of potential risk factors with PAD.
Of 2772 participants (mean age 57.3, 65.2% female), 35.8% were overweight, 38.1% obese, 32.4% had diabetes, 60% hypertension, and 15.4% reported heart. ABI prevalence (95% CI) by category was PAD 4.4% (3.6%, 5.1%), borderline 5.2% (4.4%, 6.1%), normal 87.0% (85.8%, 88.3%) and noncompressible 3.4% (2.7%, 4.0%). Female sex (OR 1.72, 95% CI 1.07 to 2.77), diabetes (OR 2.23, 95% CI 1.47 to 3.4), heart disease history (OR 1.74, 95% CI 1.07 to 2.83) and less than high school education vs having a university degree (OR 2.49, 95% CI 1.19 to 5.22) were independently associated with PAD.
Testing one leg only would underestimate PAD prevalence. Increasing the ABI cutoff for identifying PAD to <1.0 when using oscillometric devices is suggested by some studies but would more than double the estimated prevalence. Guidelines need to address this issue. Female sex and lower educational attainment are important considerations when screening. While diabetes and a history of heart disease were confirmed as risk factors, the lack of association of increasing age and cigarette smoking with PAD was unexpected.
外周动脉疾病（PAD）表明全身性动脉粥样硬化疾病，但通常无症状。ECHORN 队列研究参与者研究了 PAD 的患病率和潜在危险因素。
在巴巴多斯、波多黎各、特立尼达和多巴哥以及美属维尔京群岛的社区居住的 40 岁及以上人群中招募了有代表性的样本。调查包括糖尿病、高血压、心脏病和吸烟状况的问题。测定体重指数、HbA1c、血糖和血脂。用踝肱指数（ABI）评估一条腿。使用振荡测量设备同时测量手臂和腿部的收缩压。ABI 分类为 PAD≤0.90、边界 0.91 至 0.99、正常 1.00 至 1.40、不可压缩>0.40。多变量逻辑回归测试了潜在危险因素与 PAD 的关联。
在 2772 名参与者中（平均年龄 57.3 岁，65.2%为女性），35.8%超重，38.1%肥胖，32.4%患有糖尿病，60%患有高血压，15.4%报告有心脏病。按类别划分的 ABI 患病率（95%CI）为 PAD 4.4%（3.6%，5.1%）、边界 5.2%（4.4%，6.1%）、正常 87.0%（85.8%，88.3%）和不可压缩 3.4%（2.7%，4.0%）。女性（OR 1.72，95%CI 1.07 至 2.77）、糖尿病（OR 2.23，95%CI 1.47 至 3.4）、心脏病史（OR 1.74，95%CI 1.07 至 2.83）和受教育程度低于高中而不是大学（OR 2.49，95%CI 1.19 至 5.22）与 PAD 独立相关。
仅测试一条腿会低估 PAD 的患病率。一些研究建议，使用振荡测量设备时，将识别 PAD 的 ABI 截断值提高到<1.0，但这将使估计的患病率增加一倍以上。指南需要解决这个问题。女性和较低的教育程度是筛选时的重要考虑因素。虽然糖尿病和心脏病史被确认为危险因素，但年龄增加和吸烟与 PAD 之间缺乏关联是出乎意料的。
