Associations of Obesity With Incident Hospitalization Related to Peripheral Artery Disease and Critical Limb Ischemia in the ARIC Study

BACKGROUND: We conducted an analysis of data from the ARIC (Atherosclerosis Risk in Communities) study to assess the independent association of obesity with peripheral artery disease (PAD) and critical limb ischemia (CLI). METHODS AND RESULTS: All black and white ARIC participants without prevalent PAD at baseline (1987–1989) were included. We used Cox proportional hazards models adjusting for potential confounders and then potential mediators to quantify the association between body mass index (BMI) and incident hospitalizations related to PAD without CLI and with CLI through 2013. Our analysis included 13 988 men and women followed for a median of 24 years. Incident PAD without CLI and PAD with CLI occurred in 373 and 201 participants, respectively. After adjusting for potential confounders, higher BMI at baseline was associated with increased risk of PAD without CLI when BMI was modeled continuously (hazard ratio per 1‐SD increment in BMI: 1.23; 95% confidence interval, 1.11–1.37) and with PAD with CLI regardless of whether BMI was modeled categorically (P<0.05) or continuously (hazard ratio per 1‐SD increment in BMI: 1.51; 95% confidence interval, 1.34–1.69). The associations of BMI with PAD without CLI and with CLI were attenuated after further accounting for potential mediators but remained significant for PAD with CLI when BMI was linearly modeled (hazard ratio per 1‐SD increment in BMI: 1.19; 95% confidence interval, 1.04–1.36). The positive association between BMI and PAD with CLI was stronger than the association between BMI and PAD without CLI for all models (P<0.001). CONCLUSIONS: In the general population, BMI is positively associated with incident hospitalized PAD after adjusting for potential confounders, particularly its most severe form of CLI. Maintaining an optimal weight, in addition to controlling other cardiovascular risk factors, may play a role in reducing risk of PAD with CLI.