Socioeconomic Status Tied to PAD Risk

Peripheral artery disease was more common in low socioeconomic groups

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) Past research has linked lower socioeconomic status to a higher risk for heart disease. A new study now suggests that low socioeconomic status might be linked to a specific circulatory problem.

In this new study, people from the lowest socioeconomic group had a greater risk for peripheral artery disease (PAD) than people who were in the highest socioeconomic group.

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This study was conducted by Reena Pande, MD, and Mark Creager, MD, of Brigham and Women’s Hospital In Boston.

The researchers used data from the National Health and Nutrition Exam Survey (NHANES) that took place from 1994 to 2001 to identify people with PAD and provide information on household income and education.

PAD is when the arteries in the limbs, usually the legs, become narrowed or blocked, leading to poor circulation. People with PAD are at risk for heart attack and stroke.

In this study, the researchers took participants' ankle-brachial index, which is a blood pressure taken on their arm compared to one taken on the leg. A score of 9 or lower indicates the beginning of PAD.

The researchers identified PAD in 586 people (5.8 percent) out of a total of 6,791 people. All the participants were 40 years of age or older.

The researchers also looked at education and income of the participants. They divided the participants into six groups based on their income. In the lowest group, the family income was below the poverty line.

Measures of socioeconomic status included poverty-income ratio, which is a ratio of self-reported income relative to the poverty line.

The study showed that people with the lowest poverty-income ratio were twice as likely to have PAD as those with the highest poverty-income ratio.

The participants were also divided into five educational groups. The lowest group had less than a ninth grade education. Those in the top group had at minimum graduated from college.

While the study initially found that lower education levels were also associated with PAD, this finding was no longer significant when other factors were taken into account.

The researchers noted that education and income are only two of many potential measures of socioeconomic status, and that other measures may also have an effect on overall health, including a network of family and friends and access to resources.

"The disparities in PAD prevalence highlighted here indicate that we need dedicated approaches to PAD awareness efforts, research endeavors, and treatment strategies that focus on those individuals of low socioeconomic strata who may be most likely to be affected by PAD," the study's authors wrote.

Sarah Samaan, MD, cardiologist and physician partner at the Baylor Heart Hospital in Plano, Texas, told dailyRx News, “Smoking and diabetes are major risk factors for PAD. Although the cost of cigarettes might lead one to believe that poorer people would be less likely to smoke, in fact that is not the case. Smoking is much more prevalent amongst people of lower socioeconomic background. So is diabetes. But even when smoking, diabetes, and other risk factors were controlled for, people who lived in poverty, regardless of race or ethnicity, were still more likely to have PAD.”

There is no way to know exactly why this is, Dr. Samaan said. “The authors point out that chronic stress is one possible factor. Stress is known to raise blood levels of inflammation, which may be directly harmful to our arteries," she said.

"Overall, the study raises more questions than answers, and shows us that simply addressing known risk factors will not equalize cardiovascular risk," Dr. Samaan said.

This study was published online July 1 in Circulation: Cardiovascular Quality and Outcomes.

The authors did not disclose any conflicts of interest.

Review Date: 
July 3, 2014
Last Updated:
July 8, 2014