Peripheral arterial disease

Ethnicity and risk factors for change in the ankle-brachial index: the Multi-Ethnic Study of Atherosclerosis

BACKGROUND

The aim of this study was to determine the risk factors for conversion from a normal to either a low or high ankle-brachial index (ABI).

METHODS

Participants in the Multi-Ethnic Study of Atherosclerosis who had two separate measurements of the ABI over a 3-year time period were assessed.

RESULTS

At baseline, the mean age was 62 years and 50% were women, 28% African American, 12% Chinese, 22% Hispanic and 38% non-Hispanic White. Of the 5514 participants with a baseline ABI between 0.90 and 1.40, 89 (1.6%) had an ABI < or = 0.90 ("low ABI group") and 71 (1.3%) had an ABI > or = 1.40 ("high ABI group") 3 years later. On multivariable analysis, the odds for having progressed into the low ABI group were significantly increased for higher baseline age, hypertension, diabetes, greater pack-years of cigarette smoking, and homocysteine levels. The odds for progression into the high ABI group were increased for male gender and higher body mass index. Compared with non-Hispanic Whites, African Americans had a significantly higher odds for progression to the low ABI group (odds ratio [OR]: 2.24, 95% confidence interval [CI]: 1.29-3.88) while having a reduced odds for progression to the high ABI group (OR: 0.50, 95% CI: 0.24-1.00). Neither Chinese nor Hispanic ethnicity was significantly associated with progression to either ABI group.

CONCLUSIONS

The risk factors for progression to a low or high ABI were distinct and African Americans were at increased risk for progression to a low ABI but at decreased risk for progression into the high ABI group.

Overview of geriatrics

The care of older adults offers many challenges and many rewards. As we move into the twenty-first century, health care providers will increasingly be called on to provide high-quality, comprehensive care for seniors. Health care professionals, including physicians, nurses, podiatrists, and therapists, need to remain current in the breadth of special issues facing the elderly. Though many seniors are fully functional, healthy, and active, a growing number, especially of the very old, suffer from multiple chronic conditions, polypharmacy, and functional dependency. Though younger patients typically present for medical care, which is focused on a single problem, seniors often have multiple, interacting conditions and competing agendas for their medical care. Professionals need to be prepared to recognize the complex interplay of aging, illness, medications, and social stressors that affect the health of their patients. Today's health care providers, more than ever, must learn to function as members of health care teams, assembled around the specific needs of individual patients in a variety of settings. Foot care is a critical part of the health of older adults, primarily to maintain an active lifestyle and secondarily as a marker of a variety of systemic diseases. Podiatrists are important members of this team and have a special role to play in the diagnosis and treatment of disease as well as helping seniors maintain a high quality of life and maximum function.