{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T22:43:37Z","timestamp":1790808217334,"version":"4.1.0"},"reference-count":39,"publisher":"American Medical Association (AMA)","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Reported risk of incident peripheral artery disease (PAD) by sex and race varies significantly and has not been reported in national cohorts among individuals free of baseline PAD.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To evaluate the association of sex and race, as well as prevalent cardiovascular risk factors, with limb outcomes in a national cohort of people with normal baseline ankle-brachial indices (ABIs).<\/jats:p>\n <\/jats:sec>\n \n Design, setting, and participants<\/jats:title>\n This cohort study was conducted using data from participants in the Veterans Affairs Birth Cohort Study (born 1945-1965), with follow-up data between January 1, 2000, and December 31, 2016. Baseline demographics were collected from 77\u202f041 participants receiving care from the Veterans Health Administration with baseline ABIs of 0.90 to 1.40 and no history of PAD. Data were analyzed from October 2019 through September 2022.<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n Sex, race, diabetes, and smoking status.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Incident PAD, defined as subsequent ABI less than 0.90, surgical or percutaneous revascularization, or nontraumatic amputation.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Of 77\u202f041 participants with normal ABIs (73\u202f822 [95.8%] men; mean [SD] age, 60.2 [5.9] years; 13\u202f080 Black [18.2%] and 54\u202f377 White [75.6%] among 71\u202f911 participants with race and ethnicity data), there were 6692 incident PAD events over a median [IQR] of 3.9 [1.7-6.9] years. Incidence rates were lower for women than men (incidence rates [IRs] per 1000 person-years, 7.4 incidents [95% CI, 6.2-8.8 incidents] vs 19.2 incidents [95% CI, 18.7-19.6 incidents]), with a lower risk of incident PAD (adjusted hazard ratio [aHR], 0.49 [95% CI, 0.41-0.59]). IRs per 1000 person-years of incident PAD were similar for Black and White participants (18.9 incidents [95% CI, 17.9-20.1 incidents] vs 18.8 incidents [95% CI, 18.3-19.4]). Compared with White participants, Black participants had increased risk of total PAD (aHR, 1.09 [95% CI, 1.02-1.16]) and nontraumatic amputation (aHR, 1.20 [95% CI, 1.06-1.36]) but not surgical or percutaneous revascularization (aHR, 1.10 [95% CI, 0.98-1.23]) or subsequent ABI less than 0.90 (aHR, 1.04 [95% CI, 0.95-1.13]). Diabetes (aHR, 1.62 [95% CI, 1.53-1.72]) and smoking (eg, current vs never: aHR, 1.76 [95% CI, 1.64-1.89]) were associated with incident PAD. Incident PAD was rare among individuals without a history of smoking or diabetes (eg, among 632 women: IR per 1000 people-years, 2.1 incidents [95% CI, 1.0-4.5 incidents]) despite an otherwise\u2013high-risk cardiovascular profile (eg, 527 women [83.4%] with hypertension).<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n This study found that the risk of PAD was approximately 50% lower in women than men and less than 10% higher for Black vs White participants, while the risk of nontraumatic amputation was 20% higher among Black compared with White participants.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2022.40188","type":"journal-article","created":{"date-parts":[[2022,11,3]],"date-time":"2022-11-03T11:32:07Z","timestamp":1667475127000},"page":"e2240188","source":"Crossref","is-referenced-by-count":18,"title":["Association of Sex and Race With Incident Peripheral Artery Disease Among Veterans With Normal Ankle-Brachial Indices"],"prefix":"10.1001","volume":"5","author":[{"given":"Aaron W.","family":"Aday","sequence":"first","affiliation":[{"name":"Vanderbilt Translational and Clinical Cardiovascular Research Center, Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meredith S.","family":"Duncan","sequence":"additional","affiliation":[{"name":"Vanderbilt Translational and Clinical Cardiovascular Research Center, Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee"},{"name":"Department of Biostatistics, College of Public Health, University of Kentucky, Lexington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olga V.","family":"Patterson","sequence":"additional","affiliation":[{"name":"VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, Salt Lake City, Utah"},{"name":"Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott L.","family":"DuVall","sequence":"additional","affiliation":[{"name":"VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, Salt Lake City, Utah"},{"name":"Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick R.","family":"Alba","sequence":"additional","affiliation":[{"name":"VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, Salt Lake City, Utah"},{"name":"Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles W.","family":"Alcorn","sequence":"additional","affiliation":[{"name":"University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hilary A.","family":"Tindle","sequence":"additional","affiliation":[{"name":"Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark A.","family":"Creager","sequence":"additional","affiliation":[{"name":"Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc P.","family":"Bonaca","sequence":"additional","affiliation":[{"name":"Colorado Prevention Center Clinical Research, Division of Cardiovascular Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott M.","family":"Damrauer","sequence":"additional","affiliation":[{"name":"Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia"},{"name":"Corporal Michael Crescenz VA Medical Center, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Quinn S.","family":"Wells","sequence":"additional","affiliation":[{"name":"Vanderbilt Translational and Clinical Cardiovascular Research Center, Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Behroozian","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, College of Public Health, University of Kentucky, Lexington"},{"name":"Now with Division of Cardiovascular Diseases, Scripps Clinic, La Jolla, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua A.","family":"Beckman","sequence":"additional","affiliation":[{"name":"Vanderbilt Translational and Clinical Cardiovascular Research Center, 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