Abstract
Objective: This study evaluates the association of self-reported race with change in ankle-brachial index (ABI) over time and modification of this association by paraoxonase gene (PON1, PON2 and PON3) single nucleotide polymorphisms (SNPs). Methods: This longitudinal study included 11,992 (N = 2952 Black, N = 9040 White) participants from the Atherosclerosis Risk in Communities (ARIC) cohort with PON genotyping. Mixed-effects models examined whether race was associated with change in ABI over time after adjustment for known peripheral artery disease (PAD) risk factors. Results: Change in ABI over time differed between Whites and Blacks (race-time interaction, p 0.0001). Stratified analyses showed that ABI values were better in both Blacks and Whites who completed high school or more education compared to those who completed less education. None of the PON SNPs met the significance level (p 0.001) after Bonferroni correction for multiple comparisons. Conclusions: ABI differences by race were small and although statistically significant, may not be clinically significant. Change in ABI over time varies by race and may be modified by education. Results suggest that higher education may influence the lifestyle and behavioral choices contributing to better ABI in both Blacks and Whites. Further studies are needed to confirm this observation.
Highlights
Peripheral artery disease (PAD) occurs most often in the lower extremities and is the third leading cause of atherosclerotic cardiovascular death after coronary artery disease and stroke [1]
This study evaluates the association of self-reported race with change in ankle-brachial index (ABI) over time and modification of this association by paraoxonase gene (PON1, PON2 and PON3) single nucleotide polymorphisms (SNPs)
The Atherosclerosis Risk in Communities Study (ARIC) [17]: is a prospective cohort study investigating the etiology of atherosclerosis, examining the risk factors and progression of subclinical to clinical cardiovascular disease events conducted in 4 communities in the United States (Washington County, MD; Forsyth County, NC; Jackson, MS; and Minneapolis, MN) with each enrolling approximately 4000 participants selected by probability sampling
Summary
Peripheral artery disease (PAD) occurs most often in the lower extremities and is the third leading cause of atherosclerotic cardiovascular death after coronary artery disease and stroke [1]. Previous studies report that ABI is a subclinical predictor of cardiovascular events [6] [7] [8] [9]. In 13,150 participants from the ARIC cohort, Gupta et al found a 40% (95%CI = 1.12, 1.74) increased risk of heart failure in those with low ABI (1.4) were significant independent predictors of CVD events and recommended inclusion of ABI to enhance the Framingham Risk Score for CVD risk prediction [8]. In the ARIC cohort, each 0.10 decline in ABI was associated with greater increase CHD hazard in Blacks than Whites [9]
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