Risk Factors for Premature Peripheral Vascular Disease: Results from the National Health and Nutritional Examination Survey 1999-2002

John S. Lane, MD, UCSF, Vascular Surgery, UCSF, San Francisco, CA; Eric Vittinghoff, PhD, San Francisco, CA; Karen T. Lane, MD, San Francisco, CA; Jade S. Hiramoto, MD, San Francisco, CA; Louis M. Messina, MD, San Francisco, CA;

Purpose: Premature peripheral vascular disease (PVD), occurring before 60yrs of age, is associated with significant cardiovascular morbidity, limb loss and death. We hypothesize that different risk factors identify PVD in patients less than 60 yrs.
Methods: 5083 participants were analyzed as part of the NHANES survey, from 1999-2002. PVD was defined as ankle-brachial index (ABI) <0.9, in subjects older and younger than 60 years. Univariate and multivariate logistic regression analyses were used to evaluate interactions between age<60yrs and the development of PVD.
Results: Multivariate analysis determined coronary artery disease (CAD) and elevated fibrinogen to be stronger predictors of PVD in patients younger than 60yrs. Chronic renal insufficiency (CRI) is more highly predictive of PVD in patients older than 60yrs. Other significant predictors, irrespective of age, in the multivariate model included: hypertension(p<.001), smoking(p<.001) and plasma homocystine(p=.067)

Multivariate Logistic Analyses for ABI<0.9

Risk Factor		Odds Ratio	Confidence Interval	P-value	P-heterogeneity
CAD	Age<60	2.90	.86 - 9.80	.084	.083
	Age≥60	1.26	.75 - 2.10	.367
Fibrinogen	Age<60	1.07	1.04 - 1.10	<.001	.034
	Age≥60	1.03	1.01 - 1.05	.001
CRI	Age<60	1.02	.93 - 1.12	.712	.006
	Age≥60	1.16	1.08 - 1.25	<.001

Conclusions: Clinicians should be aware of the high risk of developing premature PVD in patients younger than 60yrs with co-existing CAD or elevated fibrinogen. Routine screening by ABI measurements in these patients would enhance the detection of subclinical premature PVD.