Association between calf circumference and cardiovascular health indicators in patients with peripheral artery disease

OBJECTIVE: To analyze the association between calf circumference and cardiovascular indicators in men and women with symptomatic peripheral artery disease. METHODS: This cross-sectional study included 259 patients with peripheral artery disease (65% men; mean age, 67 [±12] years; ankle brachial index, 0.58 [0.26]). We measured calf circumference, brachial and central blood pressure, arterial stiffness indicators (carotid-femoral pulse wave velocity and augmentation index), and heart rate variability parameters. Multiple linear regression was used to evaluate the association between calf circumference and cardiovascular indicators after adjusting for age, ankle-brachial index, and walking capacity. RESULTS: In women, calf circumference was inversely associated with central blood pressure (systolic: β=-1.91 [0.70] mmHg, p=0.008; diastolic: β=-0.97 [0.29] mmHg, p=0.001), augmentation index (β=-1.06 [0.28]%, p<0.001), and augmentation index corrected by 75 bpm (β=-0.90 [0.23]%, p<0.001), independent of age, ankle brachial index, and walking capacity. After further adjustments for anti-hypertensive medication use and body mass index, carotid-femoral pulse wave velocity was the only parameter associated with calf circumference (β=-0.41 [0.15] m/s, p=0.010). In men, no significant association was observed between calf circumference and cardiovascular indicators (p>0.05). CONCLUSION: In women with peripheral artery disease, calf circumference was inversely associated with arterial stiffness. This finding suggests that a lower calf circumference may serve as an indicator of increased arterial stiffness in women with peripheral artery disease.