Advertisement

Body mass index and peripheral artery disease

  • Sean P. Heffron
    Affiliations
    Leon H. Charney Division of Cardiology, Department of Medicine, New York University Langone Medical Center, New York, NY, USA

    Center for the Prevention of Cardiovascular Disease, New York University Langone Medical Center, New York, NY, USA
    Search for articles by this author
  • Aeshita Dwivedi
    Affiliations
    Leon H. Charney Division of Cardiology, Department of Medicine, New York University Langone Medical Center, New York, NY, USA
    Search for articles by this author
  • Caron B. Rockman
    Affiliations
    Division of Vascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY, USA
    Search for articles by this author
  • Yuhe Xia
    Affiliations
    Division of Biostatistics, Department of Population Health, New York University Langone Medical Center, New York, NY, USA
    Search for articles by this author
  • Yu Guo
    Affiliations
    Division of Biostatistics, Department of Population Health, New York University Langone Medical Center, New York, NY, USA
    Search for articles by this author
  • Judy Zhong
    Affiliations
    Division of Biostatistics, Department of Population Health, New York University Langone Medical Center, New York, NY, USA
    Search for articles by this author
  • Jeffrey S. Berger
    Correspondence
    Corresponding author. Center for the Prevention of Cardiovascular Disease, The Leon H. Charney Division of Cardiology, New York University School of Medicine, 530 First Ave, SKI-9R, New York, NY, 10016, USA.
    Affiliations
    Leon H. Charney Division of Cardiology, Department of Medicine, New York University Langone Medical Center, New York, NY, USA

    Center for the Prevention of Cardiovascular Disease, New York University Langone Medical Center, New York, NY, USA

    Division of Vascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY, USA
    Search for articles by this author

      Highlights

      • In >3 million persons, there was a J-shaped association of BMI with prevalent PAD.
      • Overweight individuals (BMI 25–29.9 kg/m2) exhibited the lowest PAD prevalence.
      • The association of obesity with PAD was markedly stronger in women than men.

      Abstract

      Background and aims

      An independent association of body mass index (BMI) with atherosclerotic cardiovascular disease is somewhat controversial and may differ by vascular bed. Sex-specific risk factors for atherosclerosis may further modify these associations. Obesity and peripheral artery disease (PAD) are both more prevalent in women. We sought to determine the association between PAD and BMI using a very large population-based study.

      Methods

      Self-referred individuals at >20,000 US sites completed medical questionnaires including height and weight, and were evaluated by screening ankle brachial indices (ABI) for PAD (ABI<0.9).

      Results

      Among 3,250,350 individuals, the mean age was 63.1 ± 10.5 years and 65.5% were women. The mean BMI was 27.7 ± 5.8 kg/m2. 27.8% of participants were obese (BMI ≥30 kg/m2) – 27.6% females, 28.1% males. Overweight individuals (BMI 25–29.9 kg/m2) exhibited the lowest prevalence of PAD. There was a J-shaped association of BMI with prevalent PAD. After adjustment for age and cardiovascular risk factors, underweight was associated with similarly increased odds of PAD (1.72 vs. 1.39, women and men, respectively). The association of obesity with PAD was predominant in women, with only a slight association of increasing BMI with PAD in men (OR = 2.98 vs. 1.37 for BMI ≥40 kg/m2).

      Conclusions

      Our study suggests that increasing BMI is a robust independent risk factor for PAD only in women. This observation requires validation, but highlights the need for further research on sex-specific risk and mechanisms of atherosclerosis.

      Graphical abstract

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Atherosclerosis
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Thomsen M.
        • Nordestgaard B.G.
        Myocardial infarction and ischemic heart disease in overweight and obesity with and without metabolic syndrome.
        JAMA Intern. Med. 2014; 174: 15-22
        • Poirier P.
        • Giles T.D.
        • Bray G.A.
        • Hong Y.
        • Stern J.S.
        • Pi-Sunyer F.X.
        • et al.
        Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss.
        Arterioscler. Thromb. Vasc. Biol. 2006; 26: 968-976
        • Strazzullo P.
        • D'Elia L.
        • Cairella G.
        • Garbagnati F.
        • Cappuccio F.P.
        • Scalfi L.
        Excess body weight and incidence of stroke: meta-analysis of prospective studies with 2 million participants.
        Stroke. 2010; 41: e418-e426
        • Wang L.
        • Djousse L.
        • Song Y.
        • Akinkuolie A.O.
        • Matsumoto C.
        • Manson J.E.
        • et al.
        Associations of diabetes and obesity with risk of abdominal aortic aneurysm in men.
        J. Obes. 2017; 2017: 3521649
        • Bhaskaran K.
        • Dos-Santos-Silva I.
        • Leon D.A.
        • Douglas I.J.
        • Smeeth L.
        Association of BMI with overall and cause-specific mortality: a population-based cohort study of 3.6 million adults in the UK.
        Lancet Diabetes Endocrinol. 2018; 6: 944-953
        • Stackelberg O.
        • Bjorck M.
        • Sadr-Azodi O.
        • Larsson S.C.
        • Orsini N.
        • Wolk A.
        Obesity and abdominal aortic aneurysm.
        Br. J. Surg. 2013; 100: 360-366
        • Lee H.J.
        • Choi E.K.
        Risk of ischemic stroke in metabolically healthy obesity: A nationwide population-based study.
        . 2018; 13e0195210
        • Bowlin S.J.
        • Medalie J.H.
        • Flocke S.A.
        • Zyzanski S.J.
        • Goldbourt U.
        Epidemiology of intermittent claudication in middle-aged men.
        Am. J. Epidemiol. 1994; 140: 418-430
        • Ix J.H.
        • Biggs M.L.
        • Kizer J.R.
        • Mukamal K.J.
        • Djousse L.
        • Zieman S.J.
        • et al.
        Association of body mass index with peripheral arterial disease in older adults: the Cardiovascular Health Study.
        Am. J. Epidemiol. 2011; 174: 1036-1043
        • Hooi J.D.
        • Stoffers H.E.
        • Knottnerus J.A.
        • Rinkens P.E.
        • van Ree J.W.
        Asymptomatic peripheral arterial occlusive disease and erection problems.
        Br. J. Gen. Pract. 2001; 51: 404
        • Murabito J.M.
        • Evans J.C.
        • Nieto K.
        • Larson M.G.
        • Levy D.
        • Wilson P.W.
        Prevalence and clinical correlates of peripheral arterial disease in the Framingham Offspring Study.
        Am. Heart J. 2002; 143: 961-965
        • Criqui M.H.
        • Vargas V.
        • Denenberg J.O.
        • Ho E.
        • Allison M.
        • Langer R.D.
        • et al.
        Ethnicity and peripheral arterial disease: the San Diego population study.
        Circulation. 2005; 112: 2703-2707
        • Appelman Y.
        • van Rijn B.B.
        • Ten Haaf M.E.
        • Boersma E.
        • Peters S.A.
        Sex differences in cardiovascular risk factors and disease prevention.
        Atherosclerosis. 2015; 241: 211-218
        • Sigvant B.
        • Wiberg-Hedman K.
        • Bergqvist D.
        • Rolandsson O.
        • Andersson B.
        • Persson E.
        • et al.
        A population-based study of peripheral arterial disease prevalence with special focus on critical limb ischemia and sex differences.
        J. Vasc. Surg. 2007; 45: 1185-1191
        • Zheng Z.J.
        • Rosamond W.D.
        • Chambless L.E.
        • Nieto F.J.
        • Barnes R.W.
        • Hutchinson R.G.
        • et al.
        Lower extremity arterial disease assessed by ankle-brachial index in a middle-aged population of African Americans and whites: the Atherosclerosis Risk in Communities (ARIC) Study.
        Am. J. Prev. Med. 2005; 29: 42-49
        • Aboyans V.
        • Criqui M.H.
        • Abraham P.
        • Allison M.A.
        • Creager M.A.
        • Diehm C.
        • et al.
        Measurement and interpretation of the ankle-brachial index: a scientific statement from the American Heart Association.
        Circulation. 2012; 126: 2890-2909
        • WHO
        Obesity: Preventing and Managing the Global Epidemic. vol. 8. WHO Technical Report Series, Geneva2000
        • Teodorescu V.J.
        • Vavra A.K.
        • Kibbe M.R.
        Peripheral arterial disease in women.
        J. Vasc. Surg. 2013; 57: 18s-26s
        • Aboyans V.
        • Criqui M.H.
        • McClelland R.L.
        • Allison M.A.
        • McDermott M.M.
        • Goff Jr., D.C.
        • 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: 319-327
        • Srivaratharajah K.
        • Abramson B.L.
        Women and peripheral arterial disease: a review of sex differences in epidemiology, clinical manifestations, and outcomes.
        Can. J. Cardiol. 2018; 34: 356-361
        • Ray J.G.
        • Vermeulen M.J.
        • Schull M.J.
        • Redelmeier D.A.
        Cardiovascular health after maternal placental syndromes (CHAMPS): population-based retrospective cohort study.
        Lancet. 2005; 366: 1797-1803
        • Regensteiner J.G.
        • Golden S.
        • Huebschmann A.G.
        • Barrett-Connor E.
        • Chang A.Y.
        • Chyun D.
        • et al.
        Sex differences in the cardiovascular consequences of diabetes mellitus: a scientific statement from the American heart association.
        Circulation. 2015; 132: 2424-2447
        • Magnussen C.
        • Niiranen T.J.
        • Ojeda F.M.
        • Gianfagna F.
        • Blankenberg S.
        • Njolstad I.
        • et al.
        Sex differences and similarities in atrial fibrillation epidemiology, risk factors, and mortality in community cohorts: results from the BiomarCaRE consortium (biomarker for cardiovascular risk assessment in Europe).
        Circulation. 2017; 136: 1588-1597
        • Huxley R.R.
        • Woodward M.
        Cigarette smoking as a risk factor for coronary heart disease in women compared with men: a systematic review and meta-analysis of prospective cohort studies.
        Lancet. 2011; 378: 1297-1305
        • Peters S.A.
        • Huxley R.R.
        • Woodward M.
        Diabetes as a risk factor for stroke in women compared with men: a systematic review and meta-analysis of 64 cohorts, including 775,385 individuals and 12,539 strokes.
        Lancet. 2014; 383: 1973-1980
        • Huang Y.
        • Xu M.
        • Xie L.
        • Wang T.
        • Huang X.
        • Lv X.
        • et al.
        Obesity and peripheral arterial disease: a Mendelian Randomization analysis.
        Atherosclerosis. 2016; 247: 218-224
        • Steenman M.
        • Espitia O.
        • Maurel B.
        • Guyomarch B.
        • Heymann M.F.
        • Pistorius M.A.
        • et al.
        Identification of genomic differences among peripheral arterial beds in atherosclerotic and healthy arteries.
        Sci. Rep. 2018; 8: 3940
        • Shapses S.A.
        • Sukumar D.
        Bone metabolism in obesity and weight loss.
        Annu. Rev. Nutr. 2012; 32: 287-309
        • Hammoud A.
        • Gibson M.
        • Hunt S.C.
        • Adams T.D.
        • Carrell D.T.
        • Kolotkin R.L.
        • et al.
        Effect of Roux-en-Y gastric bypass surgery on the sex steroids and quality of life in obese men.
        J. Clin. Endocrinol. Metab. 2009; 94: 1329-1332
        • Elmariah S.
        • Budoff M.J.
        • Delaney J.A.
        • Hamirani Y.
        • Eng J.
        • Fuster V.
        • et al.
        Risk factors associated with the incidence and progression of mitral annulus calcification: the multi-ethnic study of atherosclerosis.
        Am. Heart J. 2013; 166: 904-912
        • Massera D.
        • Trivieri M.G.
        • Andrews J.P.M.
        • Sartori S.
        • Abgral R.
        • Chapman A.R.
        • et al.
        Disease activity in mitral annular calcification.
        Circ. Cardiovasc. Imaging. 2019; 12e008513
        • Flegal K.M.
        • Kit B.K.
        • Orpana H.
        • Graubard B.I.
        Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis.
        JAMA. 2013; 309: 71-82
        • Hughes V.
        The big fat truth.
        Nature. 2013; 497: 428-430
        • Hicks C.W.
        • Yang C.
        • Ndumele C.E.
        • Folsom A.R.
        • Heiss G.
        • Black 3rd, J.H.
        • et al.
        Associations of obesity with incident hospitalization related to peripheral artery disease and critical limb ischemia in the ARIC study.
        J. Am. Heart Assoc. 2018; 7e008644
        • Caleyachetty R.
        • Thomas G.N.
        • Toulis K.A.
        • Mohammed N.
        • Gokhale K.M.
        • Balachandran K.
        • et al.
        Metabolically healthy obese and incident cardiovascular disease events among 3.5 million men and women.
        J. Am. Coll. Cardiol. 2017; 70: 1429-1437
        • Nyholm M.
        • Gullberg B.
        • Merlo J.
        • Lundqvist-Persson C.
        • Rastam L.
        • Lindblad U.
        The validity of obesity based on self-reported weight and height: implications for population studies.
        Obesity. 2007; 15: 197-208
        • Leikauf J.
        • Federman A.D.
        Comparisons of self-reported and chart-identified chronic diseases in inner-city seniors.
        J. Am. Geriatr. Soc. 2009; 57: 1219-1225
        • Kehoe R.
        • Wu S.Y.
        • Leske M.C.
        • Chylack Jr., L.T.
        Comparing self-reported and physician-reported medical history.
        Am. J. Epidemiol. 1994; 139: 813-818
        • Merkin S.S.
        • Cavanaugh K.
        • Longenecker J.C.
        • Fink N.E.
        • Levey A.S.
        • Powe N.R.
        Agreement of self-reported comorbid conditions with medical and physician reports varied by disease among end-stage renal disease patients.
        J. Clin. Epidemiol. 2007; 60: 634-642
        • Newell S.A.
        • Girgis A.
        • Sanson-Fisher R.W.
        • Savolainen N.J.
        The accuracy of self-reported health behaviors and risk factors relating to cancer and cardiovascular disease in the general population: a critical review.
        Am. J. Prev. Med. 1999; 17: 211-229
        • Reis J.P.
        • Loria C.M.
        • Lewis C.E.
        • Powell-Wiley T.M.
        • Wei G.S.
        • Carr J.J.
        • et al.
        Association between duration of overall and abdominal obesity beginning in young adulthood and coronary artery calcification in middle age.
        JAMA. 2013; 310: 280-288
        • Bangalore S.
        • Fayyad R.
        • Laskey R.
        • DeMicco D.A.
        • Messerli F.H.
        • Waters D.D.
        Body-weight fluctuations and outcomes in coronary disease.
        N. Engl. J. Med. 2017; 376: 1332-1340
        • Shah B.
        • Rockman C.B.
        • Guo Y.
        • Chesner J.
        • Schwartzbard A.Z.
        • Weintraub H.S.
        • et al.
        Diabetes and vascular disease in different arterial territories.
        Diabetes Care. 2014; 37: 1636-1642
        • Schoenborn C.A.
        • Heyman K.M.
        Health characteristics of adults aged 55 Years and over: United States, 2004-2007.
        Natl. Health Stat. Rep. 2009; 16: 1-32
        • US Department of Health and Human Services
        Summary health statistics for U.S. Adults: national health interview survey.
        Vital Health Stat. 2008; 10: 1-167
        • Carroll M.D.
        • Kit B.K.
        • Lacher D.A.
        Total and high-density lipoprotein cholesterol in adults: national health and nutrition examination survey, 2009-2010.
        NCHS Data Brief. 2012; 92: 1-8
        • Sarpong E.M.
        • Zuvekas S.H.
        Changes in Statin Therapy Among Adults (Age ≥ 18) by Selected Characteristics, United States, 2000–2001 to 2010–2011.
        Medical Expenditure Panel Survey, 2014
        • Go A.S.
        • Mozaffarian D.
        • Roger V.L.
        • Benjamin E.J.
        • Berry J.D.
        • Borden W.B.
        • et al.
        Heart disease and stroke statistics--2013 update: a report from the American Heart Association.
        Circulation. 2013; 127: e6-e245
        • Stein R.A.
        • Rockman C.B.
        • Guo Y.
        • Adelman M.A.
        • Riles T.
        • Hiatt W.R.
        • et al.
        Association between physical activity and peripheral artery disease and carotid artery stenosis in a self-referred population of 3 million adults.
        Arterioscler. Thromb. Vasc. Biol. 2015; 35: 206-212