Objectives Epidemiological data concerning atherosclerotic disease among older people in rural China are sparse. We seek to determine prevalence and cardiovascular risk factor profiles for peripheral artery disease (PAD) and carotid atherosclerosis (CAS) among Chinese older people living in a rural community. Methods This cross-sectional study included 1499 participants (age ≥60 years, 59.0% women) of the Confucius Hometown Aging Project in Shandong, China. From June 2010–July 2011, data were collected through interviews, clinical examinations, and laboratory tests. PAD was defined as an ankle-brachial index ≤0.9. Carotid intima-media thickness (cIMT) and carotid artery stenosis were assessed by ultrasonography. We defined moderate stenosis as carotid stenosis ≥50%, and severe stenosis as carotid stenosis ≥70%. cIMT≥1.81 mm was considered as an increased cIMT (a measure of CAS). Data were analyzed with multiple logistic models. Results The prevalence was 5.7% for PAD, 8.9% for moderate stenosis, 1.8% for severe stenosis, and 11.2% for increased cIMT. After controlling for multiple potential confounders, diabetes, an increased low-density lipoprotein cholesterol (LDL-C)/high-density lipoprotein cholesterol (HDL-C) ratio, and hypertension were significantly or marginally associated with PAD. Ever smoking, hypertension, and an increased LDL-C/HDL-C ratio were significantly associated with an increased likelihood of increased cIMT. An increasing number of those cardiovascular risk factors were significantly associated with an increasing odds ratio of PAD and increased cIMT, respectively (p for linear trend <0.001). Conclusion Among Chinese older people living in a rural community, PAD, carotid artery stenosis, and an increased cIMT are relatively uncommon. Cardiovascular risk factor profiles for PAD and CAS are slightly different, with hypertension and an increased LDL-C/HDL-C ratio being associated with an increased likelihood of both PAD and increased cIMT.
References
[1]
Selvin E, Erlinger TP (2004) Prevalence of and risk factors for peripheral arterial disease in the United States: results from the National Health and Nutrition Examination Survey, 1999–2000. Circulation 110: 738–743.
[2]
Mathur R, Hull SA, Badrick E, Robson J (2011) Cardiovascular multimorbidity: The effect of ethnicity on prevalence and risk factor management. Br J Gen Pract 61: e262–e270.
[3]
Lim S, Choi HJ, Shin H, Khang AR, Kang SM, et al. (2012) Subclinical atherosclerosis in a community-based elderly cohort: The Korean longitudinal study on health and aging. Int J Cardiol 155: 126–133.
[4]
Joosten MM, Pai JK, Bertoia ML, Rimm EB, Spiegelman D, et al. (2012) Associations between conventional cardiovascular risk factors and risk of peripheral artery disease in men. JAMA 308: 1660–1667.
[5]
Barter P, Gotto AM, LaRosa JC, Maroni J, Szarek M, et al. (2007) HDL cholesterol, very low levels of LDL cholesterol, and cardiovascular events. N Engl J Med 357: 1301–1310.
[6]
Fowkes FG, Murray GD, Butcher I, Heald CL, Lee RJ, et al. (2008) Ankle brachial index combined with Framingham Risk Score to predict cardiovascular events and mortality: a meta-analysis. JAMA 300: 197–208.
Elias-Smale SE, Kavousi M, Verwoert GC, Koller MT, Steyerberg EW, et al. (2012) Common carotid intima-media thickness in cardiovascular risk stratification of older people: the Rotterdam Study. Eur J Prev Cardiol 9: 698–705.
[9]
Wendell CR, Waldstein SR, Ferrucci L, O’Brien RJ, Strait JB, et al. (2012) Carotid atherosclerosis and prospective risk of dementia. Stroke 43: 3319–3324.
[10]
Welmer AK, Angleman S, Rydwik E, Fratiglioni L, Qiu C (2013) Association of cardiovascular burden with mobility limitation among elderly people: a population-based study. PLOS ONE 8(5): e65815.
[11]
van Oijen M, de Jong FJ, Witteman JC, Hofman A, Koudstaal PJ, et al. (2007) Atherosclerosis and risk for dementia. Ann Neurol 61: 403–410.
[12]
McDermott MM, Liu K, Criqui MH, Ruth K, Goff D, et al. (2005) Ankle-brachial index and subclinical cardiac and carotid disease: the multi-ethnic study of atherosclerosis. Am J Epidemiol 162: 33–41.
[13]
He Y, Jiang Y, Wang J, Fan L, Li X, et al. (2006) Prevalence of peripheral arterial disease and its association with smoking in a population-based study in Beijing, China. J Vasc Surg 44: 333–338.
[14]
Chien KL, Su TC, Jeng JS, Hsu HC, Chang WT, et al. (2008) Carotid artery intima-media thickness, carotid plaque and coronary heart disease and stroke in Chinese. PLOS ONE 3: e3435.
[15]
Zhan Y, Yu J, Chen R, Sun Y, Fu Y, et al. (2012) Prevalence of low ankle brachial index and its association with pulse pressure in an elderly Chinese population: A cross-sectional study. J Epidemiol 22: 454–461.
[16]
Song A, Liang Y, Yan Z, Sun B, Cai C, et al.. (2013) Highly prevalent and poorly controlled cardiovascular risk factors among Chinese elderly people living in rural community. Eur J Prev Cardiol. doi: 10.1177/2047487313487621.
[17]
World Health Organization (WHO). The STEPwise approach to surveillance (STEPS). Available: http://www.who.int/chp/steps/instrument/？en. Accessed 2013 Jun 15.
[18]
Kowal P, Chatterji S, Naidoo N, Biritwum R, Fan W, et al. (2012) Data resource profile: the World Health Organization Study on global AGEing and adult health (SAGE). Int J Epidemiol 41: 1639–1649.
[19]
Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, et al. (2003) The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: The JNC 7 report. JAMA 289: 2560–2572.
[20]
Grenon SM, Gagnon J, Hsiang Y (2009) Video in clinical medicine. Ankle-brachial index for assessment of peripheral arterial disease. N Engl J Med 361: e40.
[21]
O’Leary DH, Polak JF, Wolfson SK, Bond MG, Bommer W, et al. (1991) Use of sonography to evaluate carotid atherosclerosis in the elderly. The Cardiovascular Health Study. Stroke 22: 1155–1163.
[22]
de Weerd M, Greving JP, Hedblad B, Lorenz MW, Mathiesen EB, et al. (2010) Prevalence of asymptomatic carotid artery stenosis in the general population: an individual participant data meta-analysis. Stroke 41: 1294–1297.
[23]
O’Leary DH, Polak JF, Kronmal RA, Manolio TA, Burke GL, et al. (1999) Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. N Engl J Med 340: 14–22.
[24]
American Diabetes Association (2012) Diagnosis and classification of diabetes mellitus. Diabetes Care 35 Suppl 1S64–S71.
[25]
National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) (2002) Third report of the national cholesterol education program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III) final report. Circulation 106: 3143–3421.
[26]
Nasr N, Ruidavets JB, Farghali A, Guidolin B, Perret B, et al. (2011) Lipoprotein (a) and carotid atherosclerosis in young patients with stroke. Stroke 42: 3616–3618.
[27]
de Weerd M, Greving JP, de Jong AW, Buskens E, Bots ML (2009) Prevalence of asymptomatic carotid artery stenosis according to age and sex: systematic review and metaregression analysis. Stroke 40: 1105–1113.
[28]
Sangiorgi G, Roversi S, Biondi Zoccai G, Modena MG, Servadei F, et al. (2013) Sex-related differences in carotid plaque features and inflammation. J Vasc Surg 57: 338–344.
[29]
Johnson HM, Douglas PS, Srinivasan SR, Bond MG, Tang R, et al. (2007) Predictors of carotid intima-media thickness progression in young adults: The Bogalusa Heart Study. Stroke 38: 900–905.
[30]
Starke RM, Ali MS, Jabbour PM, Tjoumakaris SI, Gonzalez F, et al. (2013) Cigarette smoke modulates vascular smooth muscle phenotype: implications for carotid and cerebrovascular disease. PLOS ONE 8: e71954.
[31]
Enomoto M, Adachi H, Hirai Y, Fukami A, Satoh A, et al. (2011) LDL-C/HDL-C ratio predicts carotid intima-media thickness progression better than HDL-C or LDL-C alone. J Lipids 2011: 549137.
[32]
Paramsothy P, Katz R, Owens DS, Burke GL, Probstfield JL, et al. (2012) Age modification of the association of lipoprotein, lipid, and lipoprotein ratio with carotid intima-media thickness (from the Multi-Ethnic Study of Atherosclerosis[MESA]). Am J Cardiol 109: 658–664.
[33]
Ariyo AA, Thach C, Tracy R (2003) Lp(a) lipoprotein, vascular disease, and mortality in the elderly. N Engl J Med 349: 2108–2115.
[34]
Momiyama Y, Ohmori R, Fayad ZA, Tanaka N, Kato R, et al. (2012) Associations between serum lipoprotein(a) levels and the severity of coronary and aortic atherosclerosis. Atherosclerosis 222: 241–244.
[35]
Gurdasani D, Sjouke B, Tsimikas S, Hovingh GK, Luben RN, et al. (2012) Lipoprotein(a) and risk of coronary, cerebrovascular, and peripheral artery disease: the EPIC-Norfolk prospective population study. Arterioscler Thromb Vasc Biol 32: 3058–3065.
[36]
Ylitalo KR, Sowers M, Heeringa S (2011) Peripheral vascular disease and peripheral neuropathy in individuals with cardiometabolic clustering and obesity: National Health and Nutrition Examination Survey 2001–2004. Diabetes Care 34: 1642–1647.
[37]
Grundy SM (2012) Pre-diabetes, metabolic syndrome, and cardiovascular risk. J Am Coll Cardiol 59: 635–643.
[38]
Johansen OE, Birkeland KI (2003) Preventing macrovascular disease in patients with type 2 diabetes mellitus. Am J Cardiovasc Drugs 3: 283–297.
