Introduction: South Asians have low prevalence of peripheral arterial disease as measured only by low Ankle-Brachial-Index (ABI<0.9). Prevalence of high ABI is 5.58% (ABI≥1.3) and is associated with cardiovascular risk in Europeans.
Aim: We studied high ABI: its prevalence and cardiovascular risk factor associations in South Asians.
Methods: Adult South Asians (Indians, Pakistanis, and Bangladeshis) (n=274) and Europeans (n=191) were recruited. A detailed cardiovascular history was completed and ABI measured with a Doppler. Normal ABI was defined as ABI≥0.9 to ABI<1.3 and high ABI as ≥1.3. Eight South Asian and 16 European patients with low ABI<0.9 were excluded.
Results: Europeans were significantly older, had lower heart rates, higher systolic/diastolic blood pressures, higher ankle pressures, increased prevalence of myocardial infarction, transient ischaemic attack, pre-diabetes and increased pack years. South Asians had a higher waist-hip-ratio (WHR), increased prevalence of diabetes, higher eGFR, higher HbA1c, higher triglyceride and lower serum HDL, compared to Europeans. All cardiovascular drug prescriptions were significantly higher in Europeans, and anti-diabetic medications higher in South Asians. ABI was similar in Europeans and South Asians after adjustment for age, sex, WHR, diabetes, hypertension and eGFR. Prevalence of high ABI≥1.3 was similar in South Asians (23%) and Europeans (25%) even after adjustment for age. The high ABI group in Europeans had significantly increased waist and hip circumference, oral anti-diabetic medications usage but reduced pack years compared to normal ABI. In South Asians, high ABI group had significantly increased weight, height, urine albumin/creatinine ratio (P=0.03) but decreased age (P=0.02), heart rate, age of diabetes diagnosis as compared to normal ABI. Cardiovascular medications were similar.
Conclusion: Although the prevalence of high ABI is similar in the two groups the cardiovascular associations are different. Further research on high ABI and occlusive vascular disease is needed in the high risk South Asian group.
Declaration of interest: There is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.
Funding: No specific grant from any funding agency in the public, commercial or not-for-profit sector.