TY - JOUR
T1 - Joint associations of peripheral artery disease and accelerometry-based physical activity with mortality
T2 - The Hispanic Community Health Study/Study of Latinos (HCHS/SOL)
AU - Gao, Yumin
AU - Hua, Simin
AU - Mok, Yejin
AU - Salameh, Maya
AU - Qi, Qibin
AU - Chen, Guochong
AU - Williams-Nguyen, Jessica
AU - Pester, Mollie
AU - Garcia-Bedoya, Olga
AU - Sotres-Alvarez, Daniela
AU - Daviglus, Martha L.
AU - Mossavar-Rahmani, Yasmin
AU - Schrack, Jennifer A.
AU - Allison, Matthew
AU - Kaplan, Robert
AU - Matsushita, Kunihiro
N1 - Funding Information:
The Hispanic Community Health Study/Study of Latinos was carried out as a collaborative study supported by contracts from the National Heart, Lung, and Blood Institute ( NHLBI ) to the University of North Carolina ( HHSN268201300001I/N01-HC-65233 ), University of Miami ( HHSN268201300004I/N01-HC-65234 ), Albert Einstein College of Medicine ( HHSN268201300002I/N01-HC-65235 ), University of Illinois at Chicago – Northwestern University ( HHSN268201300003I/N01-HC-65236 ), and San Diego State University ( HHSN268201300005I/N01-HC-65237 ). The following Institutes/Centers/Offices have contributed to the HCHS/SOL through a transfer of funds to the NHLBI: National Institute on Minority Health and Health Disparities , National Institute on Deafness and Other Communication Disorders , National Institute of Dental and Craniofacial Research , National Institute of Diabetes and Digestive and Kidney Diseases , National Institute of Neurological Disorders and Stroke , and NIH Institution- Office of Dietary Supplements . This study was also supported by R01 HL146132 (co-PIs, Drs. Kaplan and Matsushita).
Funding Information:
There are a few potential clinical implications of the present study. First, given our finding of 3-6-fold increased mortality risk for individuals with abnormal ABI and lower physical activity level vs. those with neither, it seems worth discussing whether accelerometry-based measures should be utilized for risk stratification in patients with PAD or high ABI. Of importance, the AHA/ACC 2016 PAD Guidelines already acknowledge the value of physical activity assessment for behavioral changes in the context of exercise therapy and thus the data should be available in some patients [4]. Moreover, the number of people using personal devices with accelerometers (e.g., smartphones and smartwatches) is increasing, and indeed, a study has confirmed that lower step counts assessed by a commercial device were associated with health-related adverse outcomes [36]. Nonetheless, a standardized approach for the objective evaluation of free-living physical activity would be necessary for this measure to be taken into account clinically. Second, we observed that even mild physical activity was associated with a significant reduction in mortality risk for persons with PAD. This observation seems to further support the coverage of supervised exercise therapy for symptomatic PAD patients by the Center for Medicare & Medicaid Services [37]. Whether similar exercise programs are also beneficial for asymptomatic PAD or those with high ABI requires further studies. Lastly, the interaction by diabetes (i.e., greater activity did not necessarily result in lower mortality in individuals with abnormal ABI and diabetes) should be confirmed in future studies since we have conducted our subgroup analysis without a priori hypothesis. If confirmed, this observation will have clinical implications on exercise programs in patients with diabetes.The Hispanic Community Health Study/Study of Latinos was carried out as a collaborative study supported by contracts from the National Heart, Lung, and Blood Institute (NHLBI) to the University of North Carolina (HHSN268201300001I/N01-HC-65233), University of Miami (HHSN268201300004I/N01-HC-65234), Albert Einstein College of Medicine (HHSN268201300002I/N01-HC-65235), University of Illinois at Chicago – Northwestern University (HHSN268201300003I/N01-HC-65236), and San Diego State University (HHSN268201300005I/N01-HC-65237). The following Institutes/Centers/Offices have contributed to the HCHS/SOL through a transfer of funds to the NHLBI: National Institute on Minority Health and Health Disparities, National Institute on Deafness and Other Communication Disorders, National Institute of Dental and Craniofacial Research, National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Neurological Disorders and Stroke, and NIH Institution-Office of Dietary Supplements. This study was also supported by R01 HL146132 (co-PIs, Drs. Kaplan and Matsushita).
Publisher Copyright:
© 2022 Elsevier B.V.
PY - 2022/4
Y1 - 2022/4
N2 - Background and aims: Peripheral artery disease (PAD) and lower levels of physical activity are both associated with higher mortality. Yet, their joint prognostic impact has not been systematically examined, especially in Hispanics/Latinos, and with objective measures. We aimed to examine the joint associations of PAD and physical activity with mortality in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Methods: We studied 7,620 Hispanic/Latino adults aged 45–74 years at baseline (2008–2011) who underwent assessment of PAD with ankle-brachial index (ABI) and physical activity with hip-worn accelerometry. We calculated four physical activity measures: sedentary time, light activity, moderate/vigorous activity, and total activity counts. We quantified the relationship between ABI and mortality overall, and by tertiles of activity measures in restricted cubic splines, using multivariable Cox models accounting for sampling weights. We also assessed cross-categories of ABI and activity measures with mortality. Results: During a median follow up of 7.1 years, 314 participants died. We observed a U-shaped association of ABI with mortality overall (e.g., hazard ratio 1.80 [95%CI 1.20–2.80] at ABI 0.7 vs 1.2). This U-shaped association was generally consistent after stratifying by activity measures, but an elevated mortality risk for higher ABI was not evident in the most active tertile based on sedentary time, time in light activity, and total activity counts. In the cross-category analysis of ABI and physical activity, the highest mortality risk was consistently seen in abnormal ABI (≤0.9 or >1.4) plus the least active tertile (e.g., HR 5.61 [3.31–9.51] for light activity), compared to referent ABI (0.9–1.4) plus the other more active two tertiles, with no interactions between ABI and activity measure. Conclusions: Abnormal ABI and lower accelerometry-based physical activity were independently and jointly associated with mortality in Hispanics, suggesting the importance of simultaneously evaluating leg vascular condition and physical activity.
AB - Background and aims: Peripheral artery disease (PAD) and lower levels of physical activity are both associated with higher mortality. Yet, their joint prognostic impact has not been systematically examined, especially in Hispanics/Latinos, and with objective measures. We aimed to examine the joint associations of PAD and physical activity with mortality in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Methods: We studied 7,620 Hispanic/Latino adults aged 45–74 years at baseline (2008–2011) who underwent assessment of PAD with ankle-brachial index (ABI) and physical activity with hip-worn accelerometry. We calculated four physical activity measures: sedentary time, light activity, moderate/vigorous activity, and total activity counts. We quantified the relationship between ABI and mortality overall, and by tertiles of activity measures in restricted cubic splines, using multivariable Cox models accounting for sampling weights. We also assessed cross-categories of ABI and activity measures with mortality. Results: During a median follow up of 7.1 years, 314 participants died. We observed a U-shaped association of ABI with mortality overall (e.g., hazard ratio 1.80 [95%CI 1.20–2.80] at ABI 0.7 vs 1.2). This U-shaped association was generally consistent after stratifying by activity measures, but an elevated mortality risk for higher ABI was not evident in the most active tertile based on sedentary time, time in light activity, and total activity counts. In the cross-category analysis of ABI and physical activity, the highest mortality risk was consistently seen in abnormal ABI (≤0.9 or >1.4) plus the least active tertile (e.g., HR 5.61 [3.31–9.51] for light activity), compared to referent ABI (0.9–1.4) plus the other more active two tertiles, with no interactions between ABI and activity measure. Conclusions: Abnormal ABI and lower accelerometry-based physical activity were independently and jointly associated with mortality in Hispanics, suggesting the importance of simultaneously evaluating leg vascular condition and physical activity.
KW - Accelerometer
KW - Cardiovascular disease
KW - Peripheral artery disease
KW - Physical activity
KW - Study of Latinos
UR - http://www.scopus.com/inward/record.url?scp=85126688810&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85126688810&partnerID=8YFLogxK
U2 - 10.1016/j.atherosclerosis.2022.03.008
DO - 10.1016/j.atherosclerosis.2022.03.008
M3 - Article
C2 - 35334347
AN - SCOPUS:85126688810
SN - 0021-9150
VL - 347
SP - 55
EP - 62
JO - Atherosclerosis
JF - Atherosclerosis
ER -
