Peripheral Artery Disease and Subsequent Risk of Infectious Disease in Older Individuals: The ARIC Study

Yejin Mok, Junichi Ishigami, Pamela L. Lutsey, Hirofumi Tanaka, Michelle L. Meyer, Gerardo Heiss, Kunihiro Matsushita

Research output: Contribution to journalArticlepeer-review


Objective: To quantify the association of peripheral artery disease (PAD) with infection risk because PAD has been understudied despite recognition of atherosclerotic cardiovascular disease as a risk factor for infection. Methods: Among 5082 participants of the Atherosclerosis Risk in Communities study (aged 71 to 90 years during 2011-2013), we assessed the association of PAD status, based on clinical history and ankle-brachial index (ABI), with infection-related hospitalization (through December 2019) using multivariable Cox regression. We also cross-classified participants by PAD and coronary heart disease (CHD)/stroke status at baseline, with implications for polyvascular disease. Results: During the median follow-up of 6.5 years, there were 1677 infection-related hospitalizations. Peripheral artery disease (clinical history or ABI ≤0.90) was independently associated with the risk of overall infection (adjusted hazard ratio [HR], 1.66 [95% CI, 1.42 to 1.94] vs ABI of 1.11 to 1.20), as was borderline low ABI of 0.91 to 1.00 (adjusted HR, 1.75 [95% CI, 1.47 to 2.07]). Results were consistent across major types of infection (ie, cellulitis, bloodstream infection, pneumonia, and urinary tract infection). For overall infection, PAD plus CHD/stroke had the highest HR of hospitalized infection (1.9), and PAD alone and CHD/stroke alone showed similar HRs of 1.6. For subtypes of infection, PAD alone had the highest HR of approximately 2 for bloodstream infection; PAD alone and PAD plus CHD/stroke had a similar risk of urinary tract infection with HR of approximately 1.7. Conclusion: Peripheral artery disease and borderline low ABI were robustly associated with infection-related hospitalization of older adults. The contribution of PAD to infection risk was comparable to that of CHD/stroke, warranting clinical attention to PAD for the prevention of infectious diseases.

Original languageEnglish (US)
Pages (from-to)2065-2075
Number of pages11
JournalMayo Clinic Proceedings
Issue number11
StatePublished - Nov 2022

Bibliographical note

Funding Information:
Grant Support: The Atherosclerosis Risk in Communities study has been funded in whole or in part with Federalfunds from the National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, under Contract nos. (75N92022D00001,75N92022D00002, 75N92022D00003, 75N92022D00004, 75N92022D00005).

Funding Information:
K.M. received research funding from NHLBI and a personal fee from Fukuda Denshi outside of the submitted work. P.L.L. was partially supported by K24 HL159246. The other authors report no competing interests.

Publisher Copyright:
© 2022 Mayo Foundation for Medical Education and Research

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural


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