Associations of obesity with incident hospitalization related to peripheral artery disease and critical limb ischemia in the aric study

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Abstract

Background—We conducted an analysis of data from the ARIC (Atherosclerosis Risk in Communities) study to assess the independent association of obesity with peripheral artery disease (PAD) and critical limb ischemia (CLI). Methods and Results—All black and white ARIC participants without prevalent PAD at baseline (1987–1989) were included. We used Cox proportional hazards models adjusting for potential confounders and then potential mediators to quantify the association between body mass index (BMI) and incident hospitalizations related to PAD without CLI and with CLI through 2013. Our analysis included 13 988 men and women followed for a median of 24 years. Incident PAD without CLI and PAD with CLI occurred in 373 and 201 participants, respectively. After adjusting for potential confounders, higher BMI at baseline was associated with increased risk of PAD without CLI when BMI was modeled continuously (hazard ratio per 1-SD increment in BMI: 1.23; 95% confidence interval, 1.11–1.37) and with PAD with CLI regardless of whether BMI was modeled categorically (P<0.05) or continuously (hazard ratio per 1-SD increment in BMI: 1.51; 95% confidence interval, 1.34–1.69). The associations of BMI with PAD without CLI and with CLI were attenuated after further accounting for potential mediators but remained significant for PAD with CLI when BMI was linearly modeled (hazard ratio per 1-SD increment in BMI: 1.19; 95% confidence interval, 1.04–1.36). The positive association between BMI and PAD with CLI was stronger than the association between BMI and PAD without CLI for all models (P<0.001). Conclusions—In the general population, BMI is positively associated with incident hospitalized PAD after adjusting for potential confounders, particularly its most severe form of CLI. Maintaining an optimal weight, in addition to controlling other cardiovascular risk factors, may play a role in reducing risk of PAD with CLI.

Original languageEnglish (US)
Article numbere008644
JournalJournal of the American Heart Association
Volume7
Issue number16
DOIs
StatePublished - Aug 1 2018

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Peripheral Arterial Disease
Hospitalization
Ischemia
Extremities
Obesity
Body Mass Index
Confidence Intervals
Atherosclerosis
Proportional Hazards Models

Keywords

  • ARIC (Atherosclerosis Risk in Communities)
  • Critical limb ischemia
  • Obesity
  • Peripheral artery disease
  • Peripheral vascular disease

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{450cdfe0248f450aaef31c75b5ed7ca0,
title = "Associations of obesity with incident hospitalization related to peripheral artery disease and critical limb ischemia in the aric study",
abstract = "Background—We conducted an analysis of data from the ARIC (Atherosclerosis Risk in Communities) study to assess the independent association of obesity with peripheral artery disease (PAD) and critical limb ischemia (CLI). Methods and Results—All black and white ARIC participants without prevalent PAD at baseline (1987–1989) were included. We used Cox proportional hazards models adjusting for potential confounders and then potential mediators to quantify the association between body mass index (BMI) and incident hospitalizations related to PAD without CLI and with CLI through 2013. Our analysis included 13 988 men and women followed for a median of 24 years. Incident PAD without CLI and PAD with CLI occurred in 373 and 201 participants, respectively. After adjusting for potential confounders, higher BMI at baseline was associated with increased risk of PAD without CLI when BMI was modeled continuously (hazard ratio per 1-SD increment in BMI: 1.23; 95{\%} confidence interval, 1.11–1.37) and with PAD with CLI regardless of whether BMI was modeled categorically (P<0.05) or continuously (hazard ratio per 1-SD increment in BMI: 1.51; 95{\%} confidence interval, 1.34–1.69). The associations of BMI with PAD without CLI and with CLI were attenuated after further accounting for potential mediators but remained significant for PAD with CLI when BMI was linearly modeled (hazard ratio per 1-SD increment in BMI: 1.19; 95{\%} confidence interval, 1.04–1.36). The positive association between BMI and PAD with CLI was stronger than the association between BMI and PAD without CLI for all models (P<0.001). Conclusions—In the general population, BMI is positively associated with incident hospitalized PAD after adjusting for potential confounders, particularly its most severe form of CLI. Maintaining an optimal weight, in addition to controlling other cardiovascular risk factors, may play a role in reducing risk of PAD with CLI.",
keywords = "ARIC (Atherosclerosis Risk in Communities), Critical limb ischemia, Obesity, Peripheral artery disease, Peripheral vascular disease",
author = "Caitlin Hicks and Chao Yang and Ndumele, {Chiadi Ericson} and Folsom, {Aaron R.} and Gerardo Heiss and Black, {James Hamilton} and Elizabeth Selvin and Kunihiro Matsushita",
year = "2018",
month = "8",
day = "1",
doi = "10.1161/JAHA.118.008644",
language = "English (US)",
volume = "7",
journal = "Journal of the American Heart Association",
issn = "2047-9980",
publisher = "Wiley-Blackwell",
number = "16",

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T1 - Associations of obesity with incident hospitalization related to peripheral artery disease and critical limb ischemia in the aric study

AU - Hicks, Caitlin

AU - Yang, Chao

AU - Ndumele, Chiadi Ericson

AU - Folsom, Aaron R.

AU - Heiss, Gerardo

AU - Black, James Hamilton

AU - Selvin, Elizabeth

AU - Matsushita, Kunihiro

PY - 2018/8/1

Y1 - 2018/8/1

N2 - Background—We conducted an analysis of data from the ARIC (Atherosclerosis Risk in Communities) study to assess the independent association of obesity with peripheral artery disease (PAD) and critical limb ischemia (CLI). Methods and Results—All black and white ARIC participants without prevalent PAD at baseline (1987–1989) were included. We used Cox proportional hazards models adjusting for potential confounders and then potential mediators to quantify the association between body mass index (BMI) and incident hospitalizations related to PAD without CLI and with CLI through 2013. Our analysis included 13 988 men and women followed for a median of 24 years. Incident PAD without CLI and PAD with CLI occurred in 373 and 201 participants, respectively. After adjusting for potential confounders, higher BMI at baseline was associated with increased risk of PAD without CLI when BMI was modeled continuously (hazard ratio per 1-SD increment in BMI: 1.23; 95% confidence interval, 1.11–1.37) and with PAD with CLI regardless of whether BMI was modeled categorically (P<0.05) or continuously (hazard ratio per 1-SD increment in BMI: 1.51; 95% confidence interval, 1.34–1.69). The associations of BMI with PAD without CLI and with CLI were attenuated after further accounting for potential mediators but remained significant for PAD with CLI when BMI was linearly modeled (hazard ratio per 1-SD increment in BMI: 1.19; 95% confidence interval, 1.04–1.36). The positive association between BMI and PAD with CLI was stronger than the association between BMI and PAD without CLI for all models (P<0.001). Conclusions—In the general population, BMI is positively associated with incident hospitalized PAD after adjusting for potential confounders, particularly its most severe form of CLI. Maintaining an optimal weight, in addition to controlling other cardiovascular risk factors, may play a role in reducing risk of PAD with CLI.

AB - Background—We conducted an analysis of data from the ARIC (Atherosclerosis Risk in Communities) study to assess the independent association of obesity with peripheral artery disease (PAD) and critical limb ischemia (CLI). Methods and Results—All black and white ARIC participants without prevalent PAD at baseline (1987–1989) were included. We used Cox proportional hazards models adjusting for potential confounders and then potential mediators to quantify the association between body mass index (BMI) and incident hospitalizations related to PAD without CLI and with CLI through 2013. Our analysis included 13 988 men and women followed for a median of 24 years. Incident PAD without CLI and PAD with CLI occurred in 373 and 201 participants, respectively. After adjusting for potential confounders, higher BMI at baseline was associated with increased risk of PAD without CLI when BMI was modeled continuously (hazard ratio per 1-SD increment in BMI: 1.23; 95% confidence interval, 1.11–1.37) and with PAD with CLI regardless of whether BMI was modeled categorically (P<0.05) or continuously (hazard ratio per 1-SD increment in BMI: 1.51; 95% confidence interval, 1.34–1.69). The associations of BMI with PAD without CLI and with CLI were attenuated after further accounting for potential mediators but remained significant for PAD with CLI when BMI was linearly modeled (hazard ratio per 1-SD increment in BMI: 1.19; 95% confidence interval, 1.04–1.36). The positive association between BMI and PAD with CLI was stronger than the association between BMI and PAD without CLI for all models (P<0.001). Conclusions—In the general population, BMI is positively associated with incident hospitalized PAD after adjusting for potential confounders, particularly its most severe form of CLI. Maintaining an optimal weight, in addition to controlling other cardiovascular risk factors, may play a role in reducing risk of PAD with CLI.

KW - ARIC (Atherosclerosis Risk in Communities)

KW - Critical limb ischemia

KW - Obesity

KW - Peripheral artery disease

KW - Peripheral vascular disease

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