Prospective relationship of low cardiovascular risk factor profile at younger ages to ankle-brachial index: 39-year follow-up--the Chicago Healthy Aging Study.

Abstract

Data are sparse regarding the long-term association of favorable levels of all major cardiovascular disease risk factors (RFs) (ie, low risk [LR]) with ankle-brachial index (ABI). In 2007-2010, the Chicago Healthy Aging Study reexamined a subset of participants aged 65 to 84 years from the Chicago Heart Association Detection Project in Industry cohort (baseline examination, 1967-1973). RF groups were defined as LR (untreated blood pressure ≤ 120/≤ 80 mm Hg, untreated serum cholesterol <200 mg/dL, body mass index <25 kg/m(2), not smoking, no diabetes) or as 0 RFs, 1 RF, or 2+ RFs based on the presence of blood pressure ≥ 140/≥ 90 mm Hg or receiving treatment, serum cholesterol ≥ 240 mg/dL or receiving treatment, body mass index ≥ 30 kg/m(2), smoking, or diabetes. ABI at follow-up was categorized as indicating PAD present (≤ 0.90), as borderline PAD (0.91 to 0.99), or as normal (1.00 to 1.40). We included 1346 participants with ABI ≤ 1.40. After multivariable adjustment, the presence of fewer baseline RFs was associated with a lower likelihood of PAD at 39-year follow-up (P for trend is <0.001). Odds ratios (95% CIs) for PAD in persons with LR, 0 RFs, or 1 RF compared with those with 2+ RFs were 0.14 (0.05 to 0.44), 0.28 (0.13 to 0.59), and 0.33 (0.16 to 0.65), respectively; findings were similar for borderline PAD (P for trend is 0.005). The association was mainly due to baseline smoking status, cholesterol, and diabetes. Remaining free of adverse RFs or improving RF status over time was also associated with PAD. LR profile in younger adulthood (ages 25 to 45) is associated with the lowest prevalence of PAD and borderline PAD 39 years later.