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Occupational standing and change in the Ankle-Brachial Index: the Jackson Heart Study
  1. Ciaran P Friel1,2,
  2. Andrea T Duran2,
  3. Marwah Abdalla2,
  4. Jonathan T Unkart3,
  5. John Bellettiere3,
  6. Mario Sims4,
  7. Adolfo Correa4,
  8. Daichi Shimbo5,
  9. Keith M Diaz2
  1. 1 Feinstein Institutes of Medical Research, Northwell Health, Manhasset, New York, USA
  2. 2 Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York City, New York, USA
  3. 3 Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California, USA
  4. 4 Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
  5. 5 Division of Cardiology, Columbia University Medical Center, New York City, NY, USA
  1. Correspondence to Dr Keith M Diaz, Columbia University Medical Center, New York, NY 10032, USA; kd2442{at}


Background A growing interest in reducing occupational sitting has resulted in public health efforts to encourage intermittent standing in workplaces. However, concerns have been raised that standing for prolonged periods may expose individuals to new health hazards, including lower limb atherosclerosis. These concerns have yet to be corroborated or refuted. The purpose of this study was to investigate the association between occupational standing and adverse changes in the Ankle-Brachial Index (ABI).

Methods We studied 2121 participants from the Jackson Heart Study, a single-site community-based study of African-Americans residing in Jackson, MS. Occupational standing (‘never/seldom’, ‘sometimes’, ‘often/always’) was self-reported at baseline (2000–2004). ABI was measured at baseline and again at follow-up (2009–2013).

Results Over a median follow-up of 8 years, 247 participants (11.6%) exhibited a significant decline in ABI (eg, ABI decline >0.15). In multivariable-adjusted models, higher occupational standing was not significantly associated with ABI decline (occupational standing sometimes vs never/seldom: OR 1.05; 95% CI 0.67, 1.66; occupational standing often/always vs never/seldom: OR 1.22; 95% CI 0.77, 1.94). Similarly, higher occupational standing was not associated with low ABI at follow-up reflective of peripheral artery disease (ABI <0.90) or high ABI at follow-up reflective of incompressible vessels (ABI >1.40).

Conclusions In this community-based study of African-Americans, we found no evidence that occupational standing is deleteriously associated with adverse changes in ABI over a median follow-up of 8.0 years. These findings do not provide evidence implicating occupational standing as a risk factor for lower limb atherosclerosis.

  • physical work
  • cardiovascular
  • race and ethnicity issues
  • epidemiology

Data availability statement

Data are available in a public, open access repository. Data are available at

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Data availability statement

Data are available in a public, open access repository. Data are available at

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  • Contributors CF and KMD contributed to the conception and design of the work. MS, AC and DS contributed to the acquisition of the data. KMD conducted analyses. CF and KMD drafted the manuscript. All authors critically revised the manuscript, gave final approval, and agree to be accountable for all aspects of work ensuring integrity and accuracy.

  • Funding The Jackson Heart Study (JHS) is supported and conducted in collaboration with Jackson State University (HHSN268201800013I), Tougaloo College (HHSN268201800014I), the Mississippi State Department of Health (HHSN268201800015I) and the University of Mississippi Medical Center (HHSN268201800010I, HHSN268201800011I and HHSN268201800012I) contracts from the National Heart, Lung, and Blood Institute (NHLBI) and the National Institute for Minority Health and Health Disparities (NIMHD). This work was also supported by R01‐HL117323 and K24‐HL125704 from the NHLBI/NIH. CF is supported by grant T32 HL07342-41 from the NHLBI/NIH. MA receives support through 18AMFDP34380732 from the American Heart Association and from the NHLBI/NIH (K23 HL141682-01A1).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.