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The Rotterdam Study

Wouter T. Meijer, MSc, MD, PhD; Diederick E. Grobbee, MD, PhD; M. G. Myriam Hunink, MD, PhD; Albert Hofman, MD, PhD; Arno W. Hoes, MD, PhD

Arch Intern Med. 2000;160:2934-2938.

Objective  To examine which atherosclerotic risk factors are determinants for peripheral arterial disease (PAD), we performed a population-based study in 6450 subjects (40% men, 60% women) aged 55 years and older.

Methods  The presence of PAD was assessed by measuring the ankle-arm systolic blood pressure index (AAI); PAD was considered present if the AAI was lower than 0.90 in either leg. In addition, a threshold AAI of 0.70 in either leg defined severe PAD.

Results  Determinants strongly and independently associated with PAD were age of at least 75 years (odds ratio [OR], 1.2; 95% confidence interval [CI], 1.0-1.6), fibrinogen level (OR, 1.5; 95% CI, 1.3-1.7), cigarette smoking (OR, 2.8; 95% CI, 2.3-3.4), diabetes mellitus (OR, 2.0; 95% CI, 1.6-2.5), and systolic blood pressure (OR, 1.2; 95% CI, 1.1-1.2). An inverse relation of high-density lipoprotein cholesterol level with PAD (OR, 0.7; 95% CI, 0.5-0.8) was found. Similar results were demonstrated for severe PAD. Separate analyses for men and women did not demonstrate differences in risk factors for PAD.

Conclusions  Assessment of a wide range of atherosclerotic risk factors enabled us to quantify the relative importance of each factor as determinant for PAD. In total, 69% of the occurrence of PAD is attributable to cardiovascular risk factors measured in our study; smoking accounted for most (etiologic fraction, 18.1%). The results suggest that preventive management of PAD should be directed at systolic blood pressure, fibrinogen level, smoking, high-density lipoprotein cholesterol level, and diabetes mellitus.

From the Departments of Epidemiology and Biostatistics (Drs Meijer, Hunink, Hofman, and Hoes), Radiology (Drs Meijer and Hunink), and General Practice (Dr Meijer), Erasmus University Medical Center Rotterdam, Rotterdam, and The Julius Center for General Practice and Patient Oriented Research, University Medical Center Utrecht, Utrecht (Drs Grobbee and Hoes), the Netherlands; and the Department of Health Policy and Management, Harvard School of Public Health, Boston, Mass (Dr Hunink).

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