einstein (São Paulo). 19/Aug/2025;23:eAO1089.

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

Fabiana Gonçalves

Ferreira

, Hélcio

Kanegusuku

, Wellington

Segheto

, Gabriel Grizzo

Cucato

, Nelson

Wolosker

, Raphael Mendes

Ritti-Dias

, Rosilene Motta

Elias

, Breno Quintella

Farah

, Marilia de Almeida

Correia

DOI: 10.31744/einstein_journal/2025AO1089

Highlights

■ Calf circumference is a well-established indicator of all-cause mortality.
■ In women with peripheral artery disease, calf circumference was inversely associated with arterial stiffness.
■ Among men with peripheral artery disease, calf circumference was not associated with cardiovascular indicators.
■ Calf circumference may be a useful screening tool for cardiovascular risk in women.

ABSTRACT

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.

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