Ankle-Brachial Index and Lifestyle Factors Among Women of Reproductive and Postmenopausal Age: A Cross-Sectional Study from Primary Care Settings in Croatia.

Background/Objectives: Cardiovascular diseases remain the leading cause of death among women, with peripheral arterial disease (PAD) representing an important manifestation of systemic atherosclerosis. The ankle-brachial index (ABI) is a simple, non-invasive measure used for PAD screening and cardiovascular risk assessment. This study aimed to compare ABI values between women of reproductive and postmenopausal age and to explore associations with lifestyle and clinical characteristics in primary care settings. Methods: This cross-sectional study included 437 women recruited from family medicine offices in two Croatian counties between November and December 2024. Participants completed validated questionnaires on dietary habits (MEDAS) and physical activity (IPAQ/PASE), and underwent anthropometric and blood pressure measurements. ABI was assessed using an automated MESI device following a standardized protocol. Multivariable logistic regression was performed to identify independent predictors of abnormal ABI (<1.00), adjusting for age, BMI, hypertension, smoking, and county. Results: Most participants had normal ABI values (right 95.7%; left 95.0%). Mild to moderate PAD (ABI 0.90-0.99) was observed in approximately 3% and severe PAD (ABI < 0.90) in ≤1.1% of cases. Postmenopausal women were more likely to present with lower ABI values (p = 0.046), though this association was attenuated after adjusting for age. Lifestyle factors, including diet and physical activity, showed no significant association with ABI in the adjusted models. Conclusions: Age emerged as the primary determinant of reduced ABI, while hypertension and smoking showed positive but non-significant associations. The findings underscore the importance of early vascular screening and lifestyle-based prevention in women, particularly in the postmenopausal period. Larger longitudinal studies are warranted to clarify causal pathways and the role of hormonal and behavioral factors in peripheral arterial disease development.