Lower extremity peripheral artery disease in the absence of traditional risk factors. The Multi-Ethnic Study of Atherosclerosis

Atherosclerosis. 2011 Jan;214(1):169-73. doi: 10.1016/j.atherosclerosis.2010.10.011. Epub 2010 Oct 21.


Objective: Lower-extremity peripheral artery disease (LE-PAD), is strongly related to traditional risk factors (smoking, hypertension, dyslipidemia, diabetes). We hypothesized that the prevalence of LE-PAD in the absence of traditional CVD risk factors is not negligible, and that this condition would remain associated with subclinical atherosclerosis in other territories.

Methods: In the Multi-Ethnic Study of Atherosclerosis, we classified participants without any traditional risk factor according to their ankle-brachial index (ABI) into 3 groups: low (<1.00), normal (1.00-1.30) and high (>1.30) ABI. Coronary or carotid artery diseases were defined by the presence of any coronary artery calcification (CAC score>0) or carotid plaque, respectively.

Results: Among the 6814 participants, 1932 had no traditional risk factors. A low- and high ABI were found in 176 (9%) and 149 (7.8%) cases, respectively. Lower glomerular filtration rate (OR: 0.88/10 units, p=0.04) and higher Interleukin-6 levels (OR: 1.42/natural-log unit, p=0.02) were associated with low ABI. Past smoking (cessation>10 years) and pulse pressure had borderline association with low ABI. In adjusted models, low-ABI was significantly associated with CAC prevalence (OR: 1.22, p<0.03). No significant association was found with carotid plaque.

Conclusion: In the absence of traditional CVD risk factors, LE-PAD is still common and associated with coronary artery disease.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Aged, 80 and over
  • Ankle Brachial Index
  • Atherosclerosis / diagnosis*
  • Atherosclerosis / ethnology*
  • Calcium / metabolism
  • Ethnicity
  • Female
  • Glomerular Filtration Rate
  • Humans
  • Interleukin-6 / metabolism
  • Male
  • Middle Aged
  • Peripheral Arterial Disease / diagnosis*
  • Peripheral Arterial Disease / ethnology*
  • Regression Analysis
  • Risk Factors


  • Interleukin-6
  • Calcium