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Intrinsic contribution of gender and ethnicity to normal ankle-brachial index values: the Multi-Ethnic Study of Atherosclerosis (MESA).
J Vasc Surg. 2007 Feb; 45(2):319-27.JV

Abstract

OBJECTIVE

Several studies report a higher prevalence of peripheral arterial disease (PAD) in women and among blacks. These studies based their PAD definition on an ankle-brachial index (ABI) <0.90. We hypothesized that there is an inherent contribution of gender and ethnicity to normal ABI values, independent of biologic and social disparities that exist between gender and ethnic groups. Consequently, an ABI threshold that disregards these fundamental gender-related and ethnicity-related differences could partly contribute to reported prevalence differences.

METHODS

A cross-sectional study was designed as part of the Multi-Ethnic Study of Atherosclerosis (MESA), a multicenter United States population study. We selected a subgroup of participants with unequivocally normal ABIs (1.00 to 1.30), and additionally excluded participants with any major PAD risk factor (smoking, diabetes, dyslipidemia, hypertension). In a linear model with ABI as the dependent variable, demographic, clinical, biologic, and social variables were introduced as independent factors.

RESULTS

Among 1775 healthy participants, there was no association between ABI level and subclinical cardiovascular disease (coronary calcium or carotid plaque). Male gender, weight, and high education level were positively correlated with ABI, whereas black race, triglycerides, pack-years (in past smokers), and pulse pressure were negatively correlated. In the fully adjusted model, women had about 0.02 lower ABI values than men, and blacks showed ABI values about 0.02 lower than non-Hispanic whites.

CONCLUSION

These data suggest intrinsic ethnic and gender differences in ABI. Such differences, although small in magnitude, are highly significant and can distort population estimates of disease burden.

Authors+Show Affiliations

Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, CA, USA. aboyans@unilim.frNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

17264011

Citation

Aboyans, Victor, et al. "Intrinsic Contribution of Gender and Ethnicity to Normal Ankle-brachial Index Values: the Multi-Ethnic Study of Atherosclerosis (MESA)." Journal of Vascular Surgery, vol. 45, no. 2, 2007, pp. 319-27.
Aboyans V, Criqui MH, McClelland RL, et al. Intrinsic contribution of gender and ethnicity to normal ankle-brachial index values: the Multi-Ethnic Study of Atherosclerosis (MESA). J Vasc Surg. 2007;45(2):319-27.
Aboyans, V., Criqui, M. H., McClelland, R. L., Allison, M. A., McDermott, M. M., Goff, D. C., & Manolio, T. A. (2007). Intrinsic contribution of gender and ethnicity to normal ankle-brachial index values: the Multi-Ethnic Study of Atherosclerosis (MESA). Journal of Vascular Surgery, 45(2), 319-27.
Aboyans V, et al. Intrinsic Contribution of Gender and Ethnicity to Normal Ankle-brachial Index Values: the Multi-Ethnic Study of Atherosclerosis (MESA). J Vasc Surg. 2007;45(2):319-27. PubMed PMID: 17264011.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intrinsic contribution of gender and ethnicity to normal ankle-brachial index values: the Multi-Ethnic Study of Atherosclerosis (MESA). AU - Aboyans,Victor, AU - Criqui,Michael H, AU - McClelland,Robyn L, AU - Allison,Matthew A, AU - McDermott,Mary McGrae, AU - Goff,David C,Jr AU - Manolio,Teri A, PY - 2006/08/01/received PY - 2006/10/11/accepted PY - 2007/2/1/pubmed PY - 2007/3/16/medline PY - 2007/2/1/entrez SP - 319 EP - 27 JF - Journal of vascular surgery JO - J. Vasc. Surg. VL - 45 IS - 2 N2 - OBJECTIVE: Several studies report a higher prevalence of peripheral arterial disease (PAD) in women and among blacks. These studies based their PAD definition on an ankle-brachial index (ABI) <0.90. We hypothesized that there is an inherent contribution of gender and ethnicity to normal ABI values, independent of biologic and social disparities that exist between gender and ethnic groups. Consequently, an ABI threshold that disregards these fundamental gender-related and ethnicity-related differences could partly contribute to reported prevalence differences. METHODS: A cross-sectional study was designed as part of the Multi-Ethnic Study of Atherosclerosis (MESA), a multicenter United States population study. We selected a subgroup of participants with unequivocally normal ABIs (1.00 to 1.30), and additionally excluded participants with any major PAD risk factor (smoking, diabetes, dyslipidemia, hypertension). In a linear model with ABI as the dependent variable, demographic, clinical, biologic, and social variables were introduced as independent factors. RESULTS: Among 1775 healthy participants, there was no association between ABI level and subclinical cardiovascular disease (coronary calcium or carotid plaque). Male gender, weight, and high education level were positively correlated with ABI, whereas black race, triglycerides, pack-years (in past smokers), and pulse pressure were negatively correlated. In the fully adjusted model, women had about 0.02 lower ABI values than men, and blacks showed ABI values about 0.02 lower than non-Hispanic whites. CONCLUSION: These data suggest intrinsic ethnic and gender differences in ABI. Such differences, although small in magnitude, are highly significant and can distort population estimates of disease burden. SN - 0741-5214 UR - https://www.unboundmedicine.com/medline/citation/17264011/Intrinsic_contribution_of_gender_and_ethnicity_to_normal_ankle_brachial_index_values:_the_Multi_Ethnic_Study_of_Atherosclerosis__MESA__ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0741-5214(06)01865-9 DB - PRIME DP - Unbound Medicine ER -