Prevalence And Risk Factors Of Peripheral Arterial Disease In Rural Hypertensive Patients In Lianyungang

Background:Peripheral arterial disease (PAD) is associated with morbidity and mortality of coronary heart disease and stroke. Hypertension is an independent risk factor for PAD. However, few studies have evaluated the associations of conventional risk factors, plasma homocysteine concentration and the methylenetetrahydrofolate reductase (MTHFR) gene C677T polymorphism with PAD in Chinese hypertensive population.Objective:To obtain the prevalence of PAD in rural Chinese hypertensive subjects, to identify the major determinants of PAD with hypertension and to investigate the associations of plasma homocysteine and the MTHFR C677T polymorphism with PAD among hypertensive patients.Methods:We conducted a community-based cross-sectional study in a rural region of the northern China named Lianyungang from 2008 to 2009. The Hey levels were measured by enzyme immunoassay methods and the methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism was determined by high-throughput TaqMan allelic discrimination assay. Blood pressure (BP), body mass index (BMI) and other related demographic and lifestyle information were obtained through a standard questionnaire and PAD assessment by ankle-brachial index (AB1) measurement. PAD (defined as ABI<0.9) was analyzed by multivariate logistic regression, with MTHFR C677T genotype, Hey and other potential risk factors.Results:The prevalence of PAD is 7.92%(n=278) in patients with hypertension (n=3531),6.20% among men and 9.01% among women, respectively (P=0.003). The prevalence of PAD increased with age (6.66% among hypertensive patients who were <60years of age, and 9.01%>60 years of age, respectively). The prevalence of PAD was higher in hypertensive patients with hypercholesterolemia (9.96%vs.7.42% in hypertensive patients who were>6.22mmol/L and<6.22mmol/L of total cholesterol, respectively). The prevalence of PAD increased with weight (5.56%,8.53%, and 13.73%among hypertensive patients with body-mass index 18.5to 24.9,25.0 to 29.9, and>30kg/m, respectively) but the prevalence of PAD was relatively higher when BMI<18.5kg/m. Multivariate analysis with fully adjustment showed that PAD was independently associated with age (OR1.042,95%CI 1.003-1.062), BMI (OR 1.094, 95%CI1.056-1.134) and total cholesterol (TC, OR 1.189,95%CI 1.079-1.312). Fasting blood glucose, Cr, systolic blood pressure, cigarette smoking, alcohol consumption, duration and grade of hypertension were not significantly associated with PAD in this population. On the logistic regression analysis, HHcy (OR 2.473, 95%CI 1.314-4.657, P=0.005) was independently associated with PAD risk in men in rural hypertensive patients. No association was found between MTHFR genotype and PAD, but the patients with TT genotype had a significantly elevated total plasma homocysteine than patients with CC and CT genotypes.Conclusions:our study found that age, BMI and TC were the major determinants of PAD in Chinese hypertensive patients in LianYunGang rural area. Hyperhomocysteinemia was an independent risk factor of PAD in men in rural hypertensive patients. We have not found significant association between MTHFR C677T genotype and PAD in this study. The genetic influence of the MTHFR C677T genotype on hypertensive PAD is mild although MTHFR C677T genotype polymorphism is associated with total plasma homocysteine.