Ann Surg Treat Res.  2019 Oct;97(4):210-216. 10.4174/astr.2019.97.4.210.

Risk factors for asymptomatic peripheral arterial disease in Korean population: lessons from a community-based screening

• Cho S
• Lee SH
• Joh JH

• KMID: 2459319
• DOI: http://doi.org/10.4174/astr.2019.97.4.210

Abstract

PURPOSE
Peripheral arterial disease (PAD) is a common vascular problem and has serious morbidity and mortality in advanced situations. However, the prevalence and risk factors for PAD in Korea have not been reported. The purpose of this study was to evaluate the prevalence and risk factors of PAD in the Korean population.
METHODS
The study was processed by visiting community welfare centers. Inclusion criteria were people who participated in this study. Screening was performed by history taking followed by the measurement of ankle brachial index (ABI). PAD was defined when an ABI of 0.9 or less was found in one or both legs. All statistical analyses were conducted with SPSS ver. 22.0.
RESULTS
Between January 2008 and December 2012, a total of 2,044 participants were included with 810 men (39.6%) and 1,234 women (60.4%). PAD was detected in 95 (4.6%). Borderline ABI (0.91-0.99) showed in 212 (10.4%), and severe decreased ABI defined as 0.5 or less showed in 3 (0.1%). Significant risk factors for PAD were old age (odd ratio, 1.952; P = 0.045), hypertension (odd ratio, 1.645; P = 0.050), and cardiovascular disease (odd ratio, 2.047; P = 0.039). Significant risk factors for borderline PAD were old age (odd ratio, 1.019; P = 0.024), hypertension (odd ratio, 1.461; P = 0.038), and chronic obstructive lung disease (odd ratio, 3.393; P = 0.001).
CONCLUSION
The prevalence of PAD in the Korean population was 4.6%. Old age, hypertension, and cardiovascular disease were significant risk factors for PAD. Further nationwide study is needed.

Keyword

Ankle brachial index; Peripheral arterial disease; Prevalence; Risk factors

MeSH Terms

Ankle Brachial Index
Cardiovascular Diseases
Female
Humans
Hypertension
Korea
Leg
Male
Mass Screening*
Mortality
Peripheral Arterial Disease*
Prevalence
Pulmonary Disease, Chronic Obstructive
Risk Factors*

Reference

1. Murabito JM, Evans JC, Larson MG, Nieto K, Levy D, Wilson PW, et al. The ankle-brachial index in the elderly and risk of stroke, coronary disease, and death: the Framingham Study. Arch Intern Med. 2003; 163:1939–1942.

2. Newman AB, Shemanski L, Manolio TA, Cushman M, Mittelmark M, Polak JF, et al. Ankle-arm index as a predictor of cardiovascular disease and mortality in the Cardiovascular Health Study. The Cardiovascular Health Study Group. Arterioscler Thromb Vasc Biol. 1999; 19:538–545.

3. Selvin E, Erlinger TP. Prevalence of and risk factors for peripheral arterial disease in the United States: results from the National Health and Nutrition Examination Survey, 1999-2000. Circulation. 2004; 110:738–743.

4. Lee YH, Shin MH, Kweon SS, Choi JS, Rhee JA, Ahn HR, et al. Cumulative smoking exposure, duration of smoking cessation, and peripheral arterial disease in middle-aged and older Korean men. BMC Public Health. 2011; 11:94.

5. Rhee SY, Guan H, Liu ZM, Cheng SW, Waspadji S, Palmes P, et al. Multi-country study on the prevalence and clinical features of peripheral arterial disease in Asian type 2 diabetes patients at high risk of atherosclerosis. Diabetes Res Clin Pract. 2007; 76:82–92.

6. McDermott MM. Ankle brachial index as a predictor of outcomes in peripheral arterial disease. J Lab Clin Med. 1999; 133:33–40.

7. Ahn S, Park YJ, Min SI, Kim SY, Ha J, Kim SJ, et al. High prevalence of peripheral arterial disease in Korean patients with coronary or cerebrovascular disease. J Korean Med Sci. 2012; 27:625–629.

8. Fowkes FG, Housley E, Cawood EH, Macintyre CC, Ruckley CV, Prescott RJ. Edinburgh Artery Study: prevalence of asymptomatic and symptomatic peripheral arterial disease in the general population. Int J Epidemiol. 1991; 20:384–392.

9. De Backer G, Kornitzer M, Sobolski J, Denolin H. Intermittent claudication--epidemiology and natural history. Acta Cardiol. 1979; 34:115–124.

10. Reid DD, Brett GZ, Hamilton PJ, Jarrett RJ, Keen H, Rose G. Cardiorespiratory disease and diabetes among middle-aged male Civil Servants. A study of screening and intervention. Lancet. 1974; 1:469–473.

11. Belch JJ, Topol EJ, Agnelli G, Bertrand M, Califf RM, Clement DL, et al. Critical issues in peripheral arterial disease detection and management: a call to action. Arch Intern Med. 2003; 163:884–892.

12. Hiatt WR. Medical treatment of peripheral arterial disease and claudication. N Engl J Med. 2001; 344:1608–1621.

13. Hirsch AT, Criqui MH, Treat-Jacobson D, Regensteiner JG, Creager MA, Olin JW, et al. Peripheral arterial disease detection, awareness, and treatment in primary care. JAMA. 2001; 286:1317–1324.

14. Landray MJ, Thambyrajah J, McGlynn FJ, Jones HJ, Baigent C, Kendall MJ, et al. Epidemiological evaluation of known and suspected cardiovascular risk factors in chronic renal impairment. Am J Kidney Dis. 2001; 38:537–546.

15. Lüscher TF, Creager MA, Beckman JA, Cosentino F. Diabetes and vascular disease: pathophysiology, clinical consequences, and medical therapy: part II. Circulation. 2003; 108:1655–1661.

16. McDermott MM, Green D, Greenland P, Liu K, Criqui MH, Chan C, et al. Relation of levels of hemostatic factors and inflammatory markers to the ankle brachial index. Am J Cardiol. 2003; 92:194–199.

17. O'Hare A1, Johansen K. Lower-extremity peripheral arterial disease among patients with end-stage renal disease. J Am Soc Nephrol. 2001; 12:2838–2847.

18. Ridker PM, Stampfer MJ, Rifai N. Novel risk factors for systemic atherosclerosis: a comparison of C-reactive protein, fibrinogen, homocysteine, lipoprotein(a), and standard cholesterol screening as predictors of peripheral arterial disease. JAMA. 2001; 285:2481–2485.

19. Diehm N, Diehm C. Subclinical atherosclerosis of lower limb arteries: a strong predictor for cardiovascular mortality. Eur Heart J. 2006; 27:2495–2496.

20. Menke A, Muntner P, Wildman RP, Dreisbach AW, Raggi P. Relation of borderline peripheral arterial disease to cardiovascular disease risk. Am J Cardiol. 2006; 98:1226–1230.

21. McDermott MM, Guralnik JM, Tian L, Liu K, Ferrucci L, Liao Y, et al. Associations of borderline and low normal ankle-brachial index values with functional decline at 5-year follow-up: the WALCS (Walking and Leg Circulation Study). J Am Coll Cardiol. 2009; 53:1056–1062.

22. Baxter AR, Jacobowitz GR, Guo Y, Maldonado T, Adelman MA, Berger JS, et al. Increased Prevalence of Moderate and Severe Peripheral Arterial Disease in the American Indian (AI)/Alaskan Native (AN) Population; a Study of 96,000 AI/AN. Ann Vasc Surg. 2017; 38:177–183.