Racial Heterogeneity in Treatment Effects in Peripheral Artery Disease: Insights From the CLEVER Trial (Claudication: Exercise Versus Endoluminal Revascularization)
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HomeCirculation: Cardiovascular Quality and OutcomesVol. 11, No. 4Racial Heterogeneity in Treatment Effects in Peripheral Artery Disease Free AccessResearch ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessResearch ArticlePDF/EPUBRacial Heterogeneity in Treatment Effects in Peripheral Artery DiseaseInsights From the CLEVER Trial (Claudication: Exercise Versus Endoluminal Revascularization) Yashashwi Pokharel, MD, MSCR, Philip G. Jones, MS, Garth Graham, MD, Tracie Collins, MD, MPH, Judith G. Regensteiner, PhD, Timothy P. Murphy, MD, David Cohen, MD, MSc, John A. Spertus, MD, MPH and Kim Smolderen, PhD Yashashwi PokharelYashashwi Pokharel Department of Medicine, University of Missouri–Kansas City (Y.P., G.G., D.C., J.A.S., K.S.). Department of Cardiovascular Research, Saint Luke's Mid America Heart Institute, Kansas City, Missouri (Y.P., P.G.J., G.G., D.C., J.A.S., K.S.). School of Medicine, University of Kansas, Wichita (T.C.). Department of Medicine, Center for Women's Health Research, University of Colorado School of Medicine, Denver (J.G.R.). Alpert Medical School of Brown University, Rhode Island Hospital, Providence (T.P.M.). , Philip G. JonesPhilip G. Jones Department of Medicine, University of Missouri–Kansas City (Y.P., G.G., D.C., J.A.S., K.S.). Department of Cardiovascular Research, Saint Luke's Mid America Heart Institute, Kansas City, Missouri (Y.P., P.G.J., G.G., D.C., J.A.S., K.S.). School of Medicine, University of Kansas, Wichita (T.C.). Department of Medicine, Center for Women's Health Research, University of Colorado School of Medicine, Denver (J.G.R.). Alpert Medical School of Brown University, Rhode Island Hospital, Providence (T.P.M.). , Garth GrahamGarth Graham Department of Medicine, University of Missouri–Kansas City (Y.P., G.G., D.C., J.A.S., K.S.). Department of Cardiovascular Research, Saint Luke's Mid America Heart Institute, Kansas City, Missouri (Y.P., P.G.J., G.G., D.C., J.A.S., K.S.). School of Medicine, University of Kansas, Wichita (T.C.). Department of Medicine, Center for Women's Health Research, University of Colorado School of Medicine, Denver (J.G.R.). Alpert Medical School of Brown University, Rhode Island Hospital, Providence (T.P.M.). , Tracie CollinsTracie Collins Department of Medicine, University of Missouri–Kansas City (Y.P., G.G., D.C., J.A.S., K.S.). Department of Cardiovascular Research, Saint Luke's Mid America Heart Institute, Kansas City, Missouri (Y.P., P.G.J., G.G., D.C., J.A.S., K.S.). School of Medicine, University of Kansas, Wichita (T.C.). Department of Medicine, Center for Women's Health Research, University of Colorado School of Medicine, Denver (J.G.R.). Alpert Medical School of Brown University, Rhode Island Hospital, Providence (T.P.M.). , Judith G. RegensteinerJudith G. Regensteiner Department of Medicine, University of Missouri–Kansas City (Y.P., G.G., D.C., J.A.S., K.S.). Department of Cardiovascular Research, Saint Luke's Mid America Heart Institute, Kansas City, Missouri (Y.P., P.G.J., G.G., D.C., J.A.S., K.S.). School of Medicine, University of Kansas, Wichita (T.C.). Department of Medicine, Center for Women's Health Research, University of Colorado School of Medicine, Denver (J.G.R.). Alpert Medical School of Brown University, Rhode Island Hospital, Providence (T.P.M.). , Timothy P. MurphyTimothy P. Murphy Department of Medicine, University of Missouri–Kansas City (Y.P., G.G., D.C., J.A.S., K.S.). Department of Cardiovascular Research, Saint Luke's Mid America Heart Institute, Kansas City, Missouri (Y.P., P.G.J., G.G., D.C., J.A.S., K.S.). School of Medicine, University of Kansas, Wichita (T.C.). Department of Medicine, Center for Women's Health Research, University of Colorado School of Medicine, Denver (J.G.R.). Alpert Medical School of Brown University, Rhode Island Hospital, Providence (T.P.M.). , David CohenDavid Cohen Department of Medicine, University of Missouri–Kansas City (Y.P., G.G., D.C., J.A.S., K.S.). Department of Cardiovascular Research, Saint Luke's Mid America Heart Institute, Kansas City, Missouri (Y.P., P.G.J., G.G., D.C., J.A.S., K.S.). School of Medicine, University of Kansas, Wichita (T.C.). Department of Medicine, Center for Women's Health Research, University of Colorado School of Medicine, Denver (J.G.R.). Alpert Medical School of Brown University, Rhode Island Hospital, Providence (T.P.M.). , John A. SpertusJohn A. Spertus Department of Medicine, University of Missouri–Kansas City (Y.P., G.G., D.C., J.A.S., K.S.). Department of Cardiovascular Research, Saint Luke's Mid America Heart Institute, Kansas City, Missouri (Y.P., P.G.J., G.G., D.C., J.A.S., K.S.). School of Medicine, University of Kansas, Wichita (T.C.). Department of Medicine, Center for Women's Health Research, University of Colorado School of Medicine, Denver (J.G.R.). Alpert Medical School of Brown University, Rhode Is
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Hispanics have significantly more isolated infrapopliteal disease than Black patients and non-Hispanic White patients.
“In a retrospective study of patients presenting with critical limb ischemia, Hispanics were found to have significantly more isolated infrapopliteal disease than Black patients and NHW.”
From Racial and Ethnic Disparities in Peripheral Artery Disease (2021) · cites this paper as [101]
The Methods and Results section describes a post hoc analysis of the CLEVER trial in patients with intermittent claudication, not a retrospective study of patients with critical limb ischemia. It explicitly says patients of races other than Black or White were excluded, so this paper could not have made the claimed Hispanic comparison. (LLM, conf=0.88)
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Experimental — accuracy not yet measuredNon-Hispanic White patients present most frequently with isolated aortoiliac occlusive disease compared with Black and Hispanic patients.
“Conversely, NHW presented most frequently with isolated aortoiliac occlusive disease than Black patients and Hispanic patients.101”
From Racial and Ethnic Disparities in Peripheral Artery Disease (2021) · cites this paper as [101]
The Methods and Results section describes a trial of patients with aortoiliac stenosis that excluded patients whose race was neither Black nor White. It does not compare how frequently isolated aortoiliac occlusive disease occurred across White, Black, and Hispanic patients; searches for that comparison found no supporting passage. No page numbers are available in our copy. (LLM, conf=0.76)
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Cites
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Ethnic-Specific Prevalence of Peripheral Arterial Disease in the United States
Allison, M. A., Ho, E., Denenberg, J. O., Langer, R. D., Newman, A. B., Fabsitz, R. R., & Criqui, M. H. (2007) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2006.12.010 · Cited by 574 · see citing works
Murphy, T. P., Cutlip, D. E., Regensteiner, J. G., Mohler, E. R., Cohen, D. J., Reynolds, M. R., Massaro, J. M., Lewis, B. A., Cerezo, J., Oldenburg, N. C., et al. (2011) · Circulation · doi:10.1161/circulationaha.111.075770 · Cited by 494 · see citing works
Self-citationMurphy, T. P., Cutlip, D. E., Regensteiner, J. G., Mohler, E. R., Cohen, D. J., Reynolds, M. R., Massaro, J. M., Lewis, B. A., Cerezo, J., Oldenburg, N. C., et al. (2015) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2014.12.043 · Cited by 288 · see citing works
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Racial and Ethnic Disparities in Peripheral Artery Disease
Hackler, E. L., Hamburg, N. M., & White Solaru, K. T. (2021) · Circulation Research · doi:10.1161/circresaha.121.318243 · Cited by 141 · see citing works
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Self-citationSex and Racial Disparities in Peripheral Artery Disease
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Peripheral Artery Disease Treatment: Scoping Review with ☸SAIMSARA
SAIMSARA (2026) · SAIMSARA Journal · doi:10.62487/saimsarafa4dc087
- Authors
- Pokharel, Y., Jones, P. G., Graham, G., Collins, T., Regensteiner, J. G., Murphy, T. P., Cohen, D., Spertus, J. A., & Smolderen, K.
- Affiliations
- University of Kansas (US)
- ORCID
- Venue
- Circulation: Cardiovascular Quality and Outcomes
- Published
- 2018-04
- Volume
- 11
- Issue
- 4
- Pages
- e004157-e004157
- ISSN
- 1941-7705 (ISSN-L)
- 1941-7713
- PMC
- PMC5901766
- OpenAlex
- W2797339665
- Cited by
- 6
- References
- 7
- Citations by year
- 2026: 1 · 2025: 1 · 2023: 1 · 2022: 2 · 2021: 1
- FWCI
- 0.26
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Circulation Cardiovascular Quality and Outcomes (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Heart, Lung, and Blood Institute (U01HL077221, U01HL081656, T32HL110837)
- Topics
- Health Sciences › Medicine › Surgery › Peripheral Artery Disease Management
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Vascular Procedures and Complications
- Keywords
- peripheral arterial disease, racial heterogeneity, treatment effect heterogeneity, exercise therapy, claudication, racial disparities, racial differences in treatment response, leg ischemia, racial differences in outcomes
- MeSH terms
- Walk Test, Black or African American, Canada, Exercise Therapy, Female, Humans, Intermittent Claudication, Male, Middle Aged, Quality of Life, Surveys and Questionnaires, Time Factors, United States, Treatment Outcome, Exercise Tolerance, Recovery of Function, White People, Health Status Disparities, Endovascular Procedures, Peripheral Arterial Disease
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