Prospective Relationship of Low Cardiovascular Risk Factor Profile at Younger Ages to Ankle‐Brachial Index: 39‐Year Follow‐Up—The C hicago H ealthy A ging S tudy

Background Data are sparse regarding the long‐term association of favorable levels of all major cardiovascular disease risk factors (RFs) (ie, low risk [ LR ]) with ankle‐brachial index ( ABI ). Methods and Results In 2007–2010, the C hicago H ealthy A ging S tudy reexamined a subset of participants aged 65 to 84 years from the C hicago H eart A ssociation D etection P roject in I ndustry cohort (baseline examination, 1967–1973). RF groups were defined as LR (untreated blood pressure ≤120/≤80 mm Hg, untreated serum cholesterol <200 mg/dL, body mass index <25 kg/m 2 , not smoking, no diabetes) or as 0 RF s, 1 RF , or 2+ RF s based on the presence of blood pressure ≥140/≥90 mm Hg or receiving treatment, serum cholesterol ≥240 mg/dL or receiving treatment, body mass index ≥30 kg/m 2 , smoking, or diabetes. ABI at follow‐up was categorized as indicating PAD present (≤0.90), as borderline PAD (0.91 to 0.99), or as normal (1.00 to 1.40). We included 1346 participants with ABI ≤1.40. After multivariable adjustment, the presence of fewer baseline RF s was associated with a lower likelihood of PAD at 39‐year follow‐up ( P for trend is <0.001). Odds ratios (95% CIs) for PAD in persons with LR , 0 RF s, or 1 RF compared with those with 2+ RF s were 0.14 (0.05 to 0.44), 0.28 (0.13 to 0.59), and 0.33 (0.16 to 0.65), respectively; findings were similar for borderline PAD ( P for trend is 0.005). The association was mainly due to baseline smoking status, cholesterol, and diabetes. Remaining free of adverse RF s or improving RF status over time was also associated with PAD . Conclusions LR profile in younger adulthood (ages 25 to 45) is associated with the lowest prevalence of PAD and borderline PAD 39 years later.