No abstract

No abstract

ABI values tend to decrease in the general population, although one sixth of the studied subjects had a relevant increase in this parameter.

T he ankle-brachial index (ABI) is a noninvasive, low-cost, and useful test for detecting asymptomatic peripheral artery disease (PAD). An ABI Ͻ0.9 has a sensitivity of 95% and a specificity of 99% in identifying PAD when compared with arteriography (1). A low ABI predicts risk of cardiovascular death, myocardial infarction, PAD events, and stroke (2,3). Although an elevated prevalence of a low ABI has been described in subjects with metabolic syndrome and a history of cardiovascular disease (4), there is no information of its possible association in subjects in primary prevention. The objective of the present study was to investigate the association between metabolic syndrome and the presence of asymptomatic PAD, defined by the presence of a low ABI, in subjects Ͼ60 years of age without a history of cardiovascular disease or diabetes. Also, we assessed whether the association persisted after adjustment for classical risk factors.RESEARCH DESIGN AND METHODS -The participants of the study were subjects of both genders aged 60 -79 years who accessed the Fuencarral Health Centre (Madrid) and voluntarily agreed to have an ABI measurement. Of the 1,361 subjects in whom the ABI was measured, 360 were excluded from the present study because of a diagnosis of cardiovascular disease or diabetes. The final number of participants was 1,001. Blood was taken for laboratory analyses that included fasting glucose and the lipid profile. The study was approved by the Committee on Ethics and Clinical Investigation of the Hospital Carlos III in Madrid. All of the patients gave written informed consent.Subjects were diagnosed as having the metabolic syndrome if they met at least three of the following NCEP-ATP III (Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults) criteria (5): waist circumference Ͼ102 cm in men and Ͼ88 cm in women, triglyceride concentration Ն1.70 mmol/l (150 mg/dl), HDL cholesterol Ͻ1.03 mmol/l (Ͻ40 mg/ dl) in men and Ͻ1.29 mmol/l (Ͻ50 mg/ dl) in women, blood pressure Ն130/Ն85 mmHg or on antihypertensive medication, and fasting glucose Ն6.1 mmol/l (Ͼ110 mg/dl). The ABI measurement procedure has been previously described (6). Participants who had an ABI Ͻ0.90 were categorized as having a low ABI.Assessment to determine the 10-year risk for developing coronary heart disease was carried out using the Framingham risk score (5). High-risk subjects were defined as those with a 10-year risk for coronary heart disease Ͼ20%.The statistical analyses were performed with the SPSS statistical package. Comparisons between quantitative variables were performed by unpaired Student's t test and between qualitative variables by the 2 test. Relationships between asymptomatic PAD and the other measured variables were evaluated using multiple logistic regression analyses with the dependent variable being the presence of an ABI Ͻ0.90.RESULTS -A total of 1,001 subjects (67.1% women) participated in the study. Of them, 277 (27.6%) fulfille...

Cerebrovascular disease is one of the leading causes of morbidity and mortality in developed countries. The identification of at-risk individuals is a high priority so that efficacious preventive measures can be implemented. Subjects with the highest risk of cerebrovascular diseases are those who already have had a stroke or a transient ischemic attack, and those with vascular disease in other territories, either in coronary or peripheral arteries. Other subjects at risk are those with cardiac disease, such as atrial fibrillation, those with hypertension, diabetes and smoking habit, as well as individuals with subclinical vascular disease. Although there is considerable evidence for the efficacy of preventive treatment in this population, the percentage of patients receiving optimum treatment is far from ideal. There is a need to implement strategies in the population directed towards increasing awareness of the need to establish healthy habits and adequate preventive pharmacological treatment that could reduce the incidence of this debilitating disease.