Dataset Information

Socioeconomic Status and Incidence of Hospitalization With Lower-Extremity Peripheral Artery Disease: Atherosclerosis Risk in Communities Study.

ABSTRACT:

Background

Compared to coronary heart disease, heart failure, and stroke, the relationship between low socioeconomic status (SES) and peripheral artery disease (PAD) is less well established. We examined the association between SES and incidence of hospitalization with PAD and explored whether this association can be explained by traditional cardiovascular risk factors and healthcare access.

Methods and results

A total of 12 517 participants in the Atherosclerosis Risk in Communities (ARIC) Study (1987-1989) with no prior PAD were examined. Individual-level SES was assessed from household income (low <$12 000/year, medium $12 000 to $24 999/year, and high ?$25 000/year [double to approximate to values in 2016]) and educational attainment (high school), and area-level SES from area deprivation index (quintiles). During a median follow-up of 23.6 (Interquartile range 19.6-24.5) years, 433 participants had a hospitalization with PAD. In Cox proportional hazards regression analysis, the demographically adjusted hazard ratio was 2.42 (1.81-3.23) for low household income, 2.08 (1.60-2.69) for low educational attainment, and 2.18 (1.35-3.53) for most deprived neighborhoods, compared to their high-SES counterparts. After adjustment for traditional cardiovascular risk factors and heath care access, the associations were attenuated but remained significant, particularly for income and education. Results were consistent when stratified by race (P-values for interaction >0.2 for all SES parameters).

Conclusions

Low individual- and area-level SES are strong predictors of hospitalization with PAD, in part due to increased prevalence of cardiovascular risk factors and poor access to care in these groups. Additional risk factors may also need to be identified and acted on to eliminate SES disparities in PAD hospitalization.

SUBMITTER: Vart P

PROVIDER: S-EPMC5586404 | biostudies-literature | 2017 Aug

REPOSITORIES: biostudies-literature

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Publications

Socioeconomic Status and Incidence of Hospitalization With Lower-Extremity Peripheral Artery Disease: Atherosclerosis Risk in Communities Study.

Vart Priya P Coresh Josef J Kwak Lucia L Ballew Shoshana H SH Heiss Gerardo G Matsushita Kunihiro K

Journal of the American Heart Association 20170810 8

<h4>Background</h4>Compared to coronary heart disease, heart failure, and stroke, the relationship between low socioeconomic status (SES) and peripheral artery disease (PAD) is less well established. We examined the association between SES and incidence of hospitalization with PAD and explored whether this association can be explained by traditional cardiovascular risk factors and healthcare access.<h4>Methods and results</h4>A total of 12 517 participants in the Atherosclerosis Risk in Communit ...[more]

PMID: 28862929

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Project description:BackgroundAltered adipokine secretion in dysfunctional adipose tissue facilitates the development of atherosclerotic diseases including lower extremity peripheral artery disease (PAD). Asprosin is a recently identified adipokine and displays potent regulatory role in metabolism, but the relationship between asprosin and lower extremity PAD remains uninvestigated.Methods33 type 2 diabetes mellitus (T2DM) patients (DM), 51 T2DM patients with PAD (DM + PAD) and 30 healthy normal control (NC) volunteers were recruited and the blood samples were collected for detecting the circulatory asprosin level and metabolomic screening. RNA sequencing was performed using the aorta tissues from the type 2 diabetic db/db mice and human umbilical vein endothelial cells (HUVECs) were treated with asprosin to determine its impact on the endothelial-to-mesenchymal transition (EndMT).ResultsThe circulating levels of asprosin in DM + PAD group were significantly higher than that of NC group and the DM group. Circulating asprosin level was remarkably negatively correlated with ankle-brachial index (ABI), even after adjusting for age, sex, body mass index (BMI) and other traditional risk factors of PAD. Logistic regression analysis revealed that asprosin is an independent risk factor for PAD and receiver-operator characteristic (ROC) curve determined a good sensitivity (74.5%) and specificity (74.6%) of asprosin to distinguish PAD. Data from metabolomics displayed a typical characteristics of de novo amino acid synthesis in collagen protein production by myofibroblasts in patients with PAD and activation of TGF-β signaling pathway appeared in the aortic tissue of db/db mice. Asprosin directly induces EndMT in HUVECs in a TGF-β-dependent manner as TGF-β signaling pathway inhibitor SB431542 erased the promotional effect of asprosin on EndMT.ConclusionsElevated circulatory asprosin level is an independent risk factor of lower extremity PAD and might serve as a diagnostic marker. Mechanistically, asprosin directly induces EndMT that participates in vascular injury via activation of TGF-β signaling pathway. Trial registration This trial was registered at clinicaltrials.gov as NCT05068895.

Project description:Background Underuse of cardiovascular medications for secondary prevention among individuals with peripheral artery disease (PAD) has been reported. Little is known about PAD treatment status in the Hispanic/Latino population in the United States, who may have limited access to health care and who have worse clinical outcomes than non-Hispanic individuals. Methods and Results We studied the use of cardiovascular therapies in 1244 Hispanic/Latino individuals recruited from 4 sites in the United States, including 826 individuals who reported diagnosis of PAD by physician and 418 individuals with coronary artery disease alone, in the Hispanic Community Health Study/Study of Latinos. We compared the prevalence of using antiplatelet therapy, lipid-lowering therapy and antihypertensive therapy by PAD and coronary artery disease status. Among those with PAD, we studied factors associated with taking cardiovascular medications, including demographic and socioeconomic factors, acculturation, access to health care and comorbidities, using multivariable regression models. The overall prevalence for individuals with PAD taking antiplatelet therapy, lipid-lowering therapy and, among hypertensive individuals, antihypertensive therapy was 31%, 26% and 57%, respectively. Individuals of Mexican background had the lowest use for all classes of cardiovascular medications. Older age, number of doctor visits and existing hypertension and diabetes mellitus were significantly associated with taking cardiovascular therapies in adjusted models. Compared with those with PAD alone, individuals with PAD and concurrent coronary artery disease were 1.52 (95% CI, 1.20-1.93) and 1.74 (1.30-2.32) times more likely to use antiplatelet agents and statins according to multivariable analysis. No significant difference of antihypertensive medication use was found among PAD patients with or without coronary artery disease. Conclusions Hispanic/Latino individuals with known PAD underuse cardiovascular medications recommended in clinical guidelines. More efforts should be directed to improve treatment in this important group.

Dataset Information

Socioeconomic Status and Incidence of Hospitalization With Lower-Extremity Peripheral Artery Disease: Atherosclerosis Risk in Communities Study.

Background

Methods and results

Conclusions

Publications

Socioeconomic Status and Incidence of Hospitalization With Lower-Extremity Peripheral Artery Disease: Atherosclerosis Risk in Communities Study.

Similar Datasets

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