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Joint associations of peripheral artery disease and accelerometry-based physical activity with mortality: The Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

      Highlights

      • Peripheral artery disease (PAD) and physical activity were associated with mortality.
      • Mortality risk increased greatly when PAD and low physical activity coexisted.
      • No interactions between PAD and physical activity were observed.
      • Simultaneously evaluating leg vasculature and physical activity improved prognosis.

      Abstract

      Background and aims

      Peripheral artery disease (PAD) and lower levels of physical activity are both associated with higher mortality. Yet, their joint prognostic impact has not been systematically examined, especially in Hispanics/Latinos, and with objective measures. We aimed to examine the joint associations of PAD and physical activity with mortality in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL).

      Methods

      We studied 7,620 Hispanic/Latino adults aged 45–74 years at baseline (2008–2011) who underwent assessment of PAD with ankle-brachial index (ABI) and physical activity with hip-worn accelerometry. We calculated four physical activity measures: sedentary time, light activity, moderate/vigorous activity, and total activity counts. We quantified the relationship between ABI and mortality overall, and by tertiles of activity measures in restricted cubic splines, using multivariable Cox models accounting for sampling weights. We also assessed cross-categories of ABI and activity measures with mortality.

      Results

      During a median follow up of 7.1 years, 314 participants died. We observed a U-shaped association of ABI with mortality overall (e.g., hazard ratio 1.80 [95%CI 1.20–2.80] at ABI 0.7 vs 1.2). This U-shaped association was generally consistent after stratifying by activity measures, but an elevated mortality risk for higher ABI was not evident in the most active tertile based on sedentary time, time in light activity, and total activity counts. In the cross-category analysis of ABI and physical activity, the highest mortality risk was consistently seen in abnormal ABI (≤0.9 or >1.4) plus the least active tertile (e.g., HR 5.61 [3.31–9.51] for light activity), compared to referent ABI (0.9–1.4) plus the other more active two tertiles, with no interactions between ABI and activity measure.

      Conclusions

      Abnormal ABI and lower accelerometry-based physical activity were independently and jointly associated with mortality in Hispanics, suggesting the importance of simultaneously evaluating leg vascular condition and physical activity.

      Graphical abstract

      Keywords

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      References

        • Virani S.S.
        • Alonso A.
        • Benjamin E.J.
        • et al.
        Heart disease and stroke statistics-2020 update: a report from the American heart association.
        Circulation. 2020; 141: e139-e596https://doi.org/10.1161/CIR.0000000000000757
        • Sigvant B.
        • Lundin F.
        • Wahlberg E.
        The risk of disease progression in peripheral arterial disease is higher than expected: a meta-analysis of mortality and disease progression in peripheral arterial disease.
        Eur. J. Vasc. Endovasc. Surg. 2016; 51: 395-403https://doi.org/10.1016/j.ejvs.2015.10.022
        • Ankle Brachial Index C.
        • Fowkes F.G.
        • Murray G.D.
        • et al.
        Ankle brachial index combined with Framingham Risk Score to predict cardiovascular events and mortality: a meta-analysis.
        JAMA. 2008; 300: 197-208https://doi.org/10.1001/jama.300.2.197
        • Gerhard-Herman M.D.
        • Gornik H.L.
        • Barrett C.
        • et al.
        2016 AHA/ACC guideline on the management of patients with lower extremity peripheral artery disease: a report of the American College of Cardiology/American heart association task force on clinical practice Guidelines.
        Circulation. 2017; 135: e726-e779https://doi.org/10.1161/CIR.0000000000000471
        • Grundy S.M.
        • Stone N.J.
        • Bailey A.L.
        • et al.
        2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the American College of Cardiology/American heart association task force on clinical practice Guidelines.
        J. Am. Coll. Cardiol. 2018; https://doi.org/10.1016/j.jacc.2018.11.003
        • Gardner A.W.
        • Montgomery P.S.
        • Parker D.E.
        Physical activity is a predictor of all-cause mortality in patients with intermittent claudication.
        J. Vasc. Surg. 2008; 47: 117-122https://doi.org/10.1016/j.jvs.2007.09.033
        • Garg P.K.
        • Tian L.
        • Criqui M.H.
        • et al.
        Physical activity during daily life and mortality in patients with peripheral arterial disease.
        Circulation. 2006; 114: 242-248https://doi.org/10.1161/CIRCULATIONAHA.105.605246
        • Arem H.
        • Moore S.C.
        • Patel A.
        • et al.
        Leisure time physical activity and mortality: a detailed pooled analysis of the dose-response relationship.
        JAMA Intern. Med. 2015; 175: 959-967https://doi.org/10.1001/jamainternmed.2015.0533
        • Wahid A.
        • Manek N.
        • Nichols M.
        • et al.
        Quantifying the association between physical activity and cardiovascular disease and diabetes: a systematic review and meta-analysis.
        J. Am. Heart Assoc. 2016; 5https://doi.org/10.1161/JAHA.115.002495
        • Nocon M.
        • Hiemann T.
        • Muller-Riemenschneider F.
        • Thalau F.
        • Roll S.
        • Willich S.N.
        Association of physical activity with all-cause and cardiovascular mortality: a systematic review and meta-analysis.
        Eur. J. Cardiovasc. Prev. Rehabil. 2008; 15: 239-246https://doi.org/10.1097/HJR.0b013e3282f55e09
        • Lear S.A.
        • Hu W.
        • Rangarajan S.
        • et al.
        The effect of physical activity on mortality and cardiovascular disease in 130 000 people from 17 high-income, middle-income, and low-income countries: the PURE study.
        Lancet. 2017; 390: 2643-2654https://doi.org/10.1016/S0140-6736(17)31634-3
        • Daviglus M.L.
        • Talavera G.A.
        • Aviles-Santa M.L.
        • et al.
        Prevalence of major cardiovascular risk factors and cardiovascular diseases among Hispanic/Latino individuals of diverse backgrounds in the United States.
        JAMA. 2012; 308: 1775-1784https://doi.org/10.1001/jama.2012.14517
        • Arredondo E.M.
        • Sotres-Alvarez D.
        • Stoutenberg M.
        • et al.
        Physical activity levels in U.S. Latino/hispanic adults: results from the hispanic community health study/study of Latinos.
        Am. J. Prev. Med. 2016; 50: 500-508https://doi.org/10.1016/j.amepre.2015.08.029
        • Lavange L.M.
        • Kalsbeek W.D.
        • Sorlie P.D.
        • et al.
        Sample design and cohort selection in the hispanic community health study/study of Latinos.
        Ann. Epidemiol. 2010; 20: 642-649https://doi.org/10.1016/j.annepidem.2010.05.006
        • Sorlie P.D.
        • Aviles-Santa L.M.
        • Wassertheil-Smoller S.
        • et al.
        Design and implementation of the hispanic community health study/study of Latinos.
        Ann. Epidemiol. 2010; 20: 629-641https://doi.org/10.1016/j.annepidem.2010.03.015
        • Choi L.
        • Liu Z.
        • Matthews C.E.
        • Buchowski M.S.
        Validation of accelerometer wear and nonwear time classification algorithm.
        Med. Sci. Sports Exerc. 2011; 43: 357-364https://doi.org/10.1249/MSS.0b013e3181ed61a3
        • Elagizi A.
        • Kachur S.
        • Carbone S.
        • Lavie C.J.
        • Blair S.N.
        A review of obesity, physical activity, and cardiovascular disease.
        Curr Obes Rep. 2020; https://doi.org/10.1007/s13679-020-00403-z
        • Colley R.C.
        • Tremblay M.S.
        Moderate and vigorous physical activity intensity cut-points for the Actical accelerometer.
        J. Sports Sci. 2011; 29: 783-789https://doi.org/10.1080/02640414.2011.557744
        • Wong S.L.
        • Colley R.
        • Connor Gorber S.
        • Tremblay M.
        Actical accelerometer sedentary activity thresholds for adults.
        J. Phys. Activ. Health. 2011; 8: 587-591
        • Moon J.Y.
        • Wang T.
        • Sofer T.
        • et al.
        Objectively measured physical activity, sedentary behavior, and genetic predisposition to obesity in U.S. Hispanics/Latinos: results from the hispanic community health study/study of Latinos (HCHS/SOL).
        Diabetes. 2017; 66: 3001-3012https://doi.org/10.2337/db17-0573
        • Willett W.
        • Stampfer M.J.
        Total energy intake: implications for epidemiologic analyses.
        Am. J. Epidemiol. 1986; 124: 17-27https://doi.org/10.1093/oxfordjournals.aje.a114366
        • Wang J.C.
        • Criqui M.H.
        • Denenberg J.O.
        • McDermott M.M.
        • Golomb B.A.
        • Fronek A.
        Exertional leg pain in patients with and without peripheral arterial disease.
        Circulation. 2005; 112: 3501-3508https://doi.org/10.1161/CIRCULATIONAHA.105.548099
        • Criqui M.H.
        • Denenberg J.O.
        • Bird C.E.
        • Fronek A.
        • Klauber M.R.
        • Langer R.D.
        The correlation between symptoms and non-invasive test results in patients referred for peripheral arterial disease testing.
        Vasc. Med. 1996; 1: 65-71https://doi.org/10.1177/1358863X9600100112
        • The Hispanic Community Health Study
        Central Laboratory Procedures.
        2011
        • American Diabetes A.
        Standards of medical care in diabetes--2010.
        Diabetes Care. 2010; 33: S11-S61https://doi.org/10.2337/dc10-S011
        • McDermott M.M.
        • Liu K.
        • Greenland P.
        • et al.
        Functional decline in peripheral arterial disease: associations with the ankle brachial index and leg symptoms.
        JAMA. 2004; 292: 453-461https://doi.org/10.1001/jama.292.4.453
        • Newman J.D.
        • Navas-Acien A.
        • Kuo C.C.
        • et al.
        Peripheral arterial disease and its association with arsenic exposure and metabolism in the strong heart study.
        Am. J. Epidemiol. 2016; 184: 806-817https://doi.org/10.1093/aje/kww002
        • Resnick H.E.
        • Lindsay R.S.
        • McDermott M.M.
        • et al.
        Relationship of high and low ankle brachial index to all-cause and cardiovascular disease mortality: the Strong Heart Study.
        Circulation. 2004; 109: 733-739https://doi.org/10.1161/01.CIR.0000112642.63927.54
        • Suominen V.
        • Rantanen T.
        • Venermo M.
        • Saarinen J.
        • Salenius J.
        Prevalence and risk factors of PAD among patients with elevated ABI.
        Eur. J. Vasc. Endovasc. Surg. 2008; 35: 709-714https://doi.org/10.1016/j.ejvs.2008.01.013
        • Velescu A.
        • Clara A.
        • Marti R.
        • et al.
        Abnormally high ankle-brachial index is associated with all-cause and cardiovascular mortality: the REGICOR study.
        Eur. J. Vasc. Endovasc. Surg. 2017; 54: 370-377https://doi.org/10.1016/j.ejvs.2017.06.002
        • Orchard T.J.
        • Strandness Jr., D.E.
        Assessment of peripheral vascular disease in diabetes. Report and recommendations of an international workshop sponsored by the American Diabetes Association and the American Heart Association September 18-20, 1992 New Orleans, Louisiana.
        Circulation. 1993; 88: 819-828https://doi.org/10.1161/01.cir.88.2.819
        • Aboyans V.
        • Ho E.
        • Denenberg J.O.
        • Ho L.A.
        • Natarajan L.
        • Criqui M.H.
        The association between elevated ankle systolic pressures and peripheral occlusive arterial disease in diabetic and nondiabetic subjects.
        J. Vasc. Surg. 2008; 48: 1197-1203https://doi.org/10.1016/j.jvs.2008.06.005
        • Ashor A.W.
        • Lara J.
        • Siervo M.
        • Celis-Morales C.
        • Mathers J.C.
        Effects of exercise modalities on arterial stiffness and wave reflection: a systematic review and meta-analysis of randomized controlled trials.
        PLoS One. 2014; 9e110034https://doi.org/10.1371/journal.pone.0110034
        • Tanaka H.
        • Dinenno F.A.
        • Monahan K.D.
        • Clevenger C.M.
        • DeSouza C.A.
        • Seals D.R.
        Aging, habitual exercise, and dynamic arterial compliance.
        Circulation. 2000; 102: 1270-1275https://doi.org/10.1161/01.cir.102.11.1270
        • Dempsey P.C.
        • Strain T.
        • Khaw K.T.
        • Wareham N.J.
        • Brage S.
        • Wijndaele K.
        Prospective associations of accelerometer-measured physical activity and sedentary time with incident cardiovascular disease, cancer, and all-cause mortality.
        Circulation. 2020; 141: 1113-1115https://doi.org/10.1161/CIRCULATIONAHA.119.043030
        • Low C.A.
        • Bovbjerg D.H.
        • Ahrendt S.
        • et al.
        Fitbit step counts during inpatient recovery from cancer surgery as a predictor of readmission.
        Ann. Behav. Med. 2018; 52: 88-92https://doi.org/10.1093/abm/kax022
      1. Jensen TS, Chin J, L. A, J. S, D. D. National Coverage Determination for Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD). Centers for Medicare & Medicaid Services. (https://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=287).