PAD, Low Levels of Physical Activity Linked to Higher Mortality in Hispanic Patients

Peripheral artery disease measuring for patient ankle-brachial index (ABI) test limb ischemia
Investigators examined the relationship among physical activity, peripheral artery disease, and mortality in Hispanic and Latino patients.

Abnormal ankle-brachial index (ABI) and lower accelerometry-based physical activity are independently associated with mortality among Hispanic individuals with peripheral artery disease (PAD). These findings were published in the journal Atherosclerosis.

Using data from the prospective Hispanic Community Health Study/Study of Latinos (HCHS/SOL), the investigators quantified the independent and joint associations of ABI and accelerometry-based physical activity with all-cause mortality over a median of 7 years of follow-up.

The HCHS/SOL community-based prospective cohort study included a total of 16,415 self-identified Hispanic and Latino adults aged between 18 and 74 years, who resided in 1 of 4 US communities (Bronx, New York; Chicago, Illinois; Miami, Florida; or San Diego, California) between 2008 and 2011. All participants were recruited with the use of a multistage probability sampling design. The HCHS/SOL included participants of Mexican, Central American, Dominican, Puerto Rican, Cuban, South American, and other or mixed Hispanic origins.

A total of 7620 Hispanic and Latino adults aged 45 to 74 years at baseline were included in the analysis. All participants underwent evaluation of PAD with ABI and physical activity with hip-worn accelerometry. Four measures of physical activity were calculated: sedentary time, light activity, moderate or vigorous activity, and total activity counts.

Across a median follow-up of 7.1 years, 314 participants died. Overall, a U-shaped association between ABI and mortality was observed (hazard ratio [HR], 1.80;

95% CI, 1.20-2.70; and HR, 1.41; 95% CI, 1.20-1.66) at ABI 0.7 and 1.5, respectively. Although this U-shaped association was generally consistent after stratifying according to activity measures, an increased mortality risk with a higher ABI was not evident in the most active tertile based on sedentary time, light activity, and total physical activity.

Per a cross-category analysis of ABI and physical activity, the highest risk for mortality was generally observed in abnormal ABI (ie, ≤0.9 or >1.4) plus the least active tertile (HR, 5.61; 95% CI, 3.31-9.51), compared with referent ABI (0.9-1.4) plus the more active 2 tertiles, with no interaction seen between ABI and activity measure.

Limitations of the study include the fact that the Hispanic adults who were included may not be representative of the overall Hispanic population in the United States, even though the center sites from HCHS/SOL are among the largest in Hispanic concentrations, based on consensus. Additionally, since the study cohort has been followed only for several years, cause-specific mortality could not be analyzed.

“…abnormal ABI (≤0.9 or >1.4) and lower accelerometry-based activity level were both independently and jointly associated with increased mortality risk even after controlling for potential confounders,” the study authors noted. “Although the clinical use of accelerometry-based measurement has yet to be established, this measurement may be especially valuable for persons with PAD.”

Disclosure: One of the study authors has declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of the author’s disclosures. 


Gao Y, Hua S, Mok Y, et al. Joint associations of peripheral artery disease and accelerometry-based physical activity with mortality: the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Atherosclerosis. Published online March 14, 2022. doi:10.1016/j.atherosclerosis.2022.03.008