IJCS | Volume 31, Nº4, July / August 2018

406 Alvim et al. Prevalence of peripheral artery disease Int J Cardiovasc Sci. 2018;31(4)405-413 Original Article on the prevalence of PAD is important to allow proper planning in public health care. Recommendations on the identification and management of this condition have been published by international medical societies. 12-14 Epidemiological studies have determined that the prevalence of PAD in the general population range from 4-10%; 15-23 however, there is a clear increase in prevalence with increasing age, 13,17,19,24 with rates as high as 20% over the age of 70 years. 19,20 Data on the prevalence of PAD in the general Brazilian population are scarce. Only one large multicenter study assessed the prevalence of PAD and found a high rate (10.5%) in 1,159 individuals in the general population. 18 Other studies have investigated the prevalence of PAD specifically in Japanese-Brazilians 25,26 and in a small sample of patients with diabetes. 27 Therefore, other large studies are needed to better access the prevalence of PAD and understand the risk factors associated with this condition in the general Brazilian population. The Baependi Heart Study is an ongoing Brazilian cohort study established in 2005 to investigate cardiovascular risk factors and heritability. 28 The study has now expanded to include other investigations such as nocturnal polygraph, heart rate variability, pulse- wave velocity, 24-hour ambulatory blood pressure monitoring, 24-hour electrocardiography (Holter), and assessment of vascular age by plethysmography. Using data collected from 2010 to 2013 from the above- mentioned research project, the present study aimed to assess the prevalence of PAD and investigate associated risk factors in different age groups. Methods Study sample The Baependi Heart Study is a genetic epidemiological study of cardiovascular disease risk factors with a longitudinal design, whose methodology has been previously described. 28 For the present analysis, we carried out a cross-sectional evaluation of data collected in the second visit of the protocol (between 2010 and 2013). This study invited 2,072 individuals (of both genders and aged 18 - 102 years), distributed across 109 families residing in the municipality of Baependi, a city in a rural area (752 km 2 , 18,072 inhabitants) located in Minas Gerais State, Southeast of Brazil. Of these, 1,634 participants underwent screening for PAD. The study protocol was approved by the ethics committee of the Hospital das Clínicas (SDC: 3485/10/074), University of São Paulo, Brazil. All procedures involved in this study are in accordance with the Declaration of Helsinki from 1975, updated in 2013. Informed consent was obtained from all participants included in the study. Anthropometric evaluations Anthropometric parameters weremeasured according to a standard protocol. 28 Height was measured in centimeters and weight in kilograms using a calibrated digital balance. Bodymass index (BMI) was calculated as body weight (kg) divided by squared height (m 2 ). Waist circumference was measured at the mean point between the lowest rib margin and the iliac crest with the subject standing and at themaximumpoint of normal expiration. Obesity was defined as a BMI ≥ 30 kg/m 2 . Blood pressure measurements Blood pressure was measured with a standard digital sphygmomanometer (OMRON, OMRON Eletrônica do Brasil Ltda., SP, Brazil) on the left arm after 5 minutes of rest, with the subject in the sitting position. Systolic (SBP) and diastolic blood pressures (DBP) were calculated from three readings (mean value of all measurements), with a minimal interval of 3 minutes. 28 Hypertension was defined as a mean SBP ≥ 140 mmHg and/or DBP ≥ 90 mmHg and/or use of antihypertensive drug. 29 Biochemical measurements Blood levels of triglycerides, total cholesterol, high-density lipoprotein cholesterol (HDL-C), low- density lipoprotein cholesterol (LDL-C), and fasting glucose were measured by standard techniques in 12-h fasting blood samples. 30 Glycated hemoglobin (HbA1c) levels were determined by high-performance liquid chromatography (National Glycohemoglobin Standardization Program, USA). Diabetes mellitus was diagnosed in the presence of a fasting glucose ≥ 126 mg/dL, HbA1c ≥ 6.5%, or use of antidiabetic drugs. Hypercholesterolemia was defined as a total cholesterol level ≥ 240 mg/dL. Assessment of risk factors and depression Physical activity level was determined by the International Physical Activity Questionnaire - Short Form (IPAQ-SF). Sedentary lifestyle was identified based on a duration of physical activity lower than 10 minutes/ day on the previous week.