OBJECTIVE: Abdominal obesity is associated with coronary heart disease (CHD) but its relationship to peripheral vascular disease (PVD) is under-researched. This study is to evaluate the association of PVD with two measures of abdominal obesity, waist-to-thigh ratio (WTR) and waist circumference (WC).

METHODS AND RESULTS: The study population consisted of 5057 adults aged 40 years or older who participated in NHANES 1999-2002. PVD was defined as an ankle-brachial index (ABI) <0.9. WTR and WC were divided into gender-specific quartiles. Of the 5057 participants, 367 (7.3%) were identified as having PVD. The cross-sectional associations were evaluated using multiple logistic regressions separately by gender. After adjusting for demographic variables and traditional risk factors of PVD, WTR was strongly associated with PVD in men. The odds ratios (95% CI) across the WTR quartiles were 4.21 (1.86,9.51), 4.44 (2.17,9.09) and 4.68 (2.13,10.32) compared to the 1st quartile (P for trend=0.018). Among women, strong linear trend was found indicating significant association between WTR and PVD (P for trend=0.007). While WC was not associated with PVD among men, among women, those in the 4th quartile of WC had an increased odds of PVD compared to the 1st quartile (odds ratio: 2.94, 95% CI: 1.01-8.88).

CONCLUSIONS: WTR is associated with PVD in men and women. In contrast, WC is associated with PVD in women, but not in men. Well-controlled prospective studies are needed to assess these two measures of body fat distribution and its association with the development of PVD in men and women.