Association of High Ankle Brachial Index With Incident Cardiovascular Disease and Mortality in a High-Risk Population

Hendriks, Eva J.E.; Westerink, Jan; Jong, Pim A. de; Borst, Gert J. de; Nathoe, Hendrik M.; Mali, Willem P.Th.M.; Graaf, Yolanda van der; Schouw, Yvonne T. van der; Beulens, Joline W.J.

doi:10.1161/atvbaha.115.306657

Cited by 48 publications

(43 citation statements)

References 23 publications

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“…Unlike the results of the SHS, high ABI was not associated with fatal and nonfatal cardiovascular events after adjustment for confounders. Recently, Hendriks et al evaluated 7,538 patients with a high risk for cardiovascular disease, and reported that high ABI was not associated with all-cause death, cardiovascular-associated death, or stroke [22]. Furthermore, few studies have reported the prognosis of Japanese patients with high ABI.…”

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics and Outcomes of Patients with High Ankle-Brachial Index from the IMPACT-ABI Study

et al. 2016

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BackgroundReduced ankle–brachial index (ABI) is a predictor of cardiovascular events. However, the significance of high ABI remains poorly understood. This study aimed to assess the characteristics and outcomes of patients with high ABI.MethodsThe IMPACT-ABI study was a retrospective cohort study that enrolled and examined ABI in 3,131 patients hospitalized for cardiovascular disease between January 2005 and December 2012. From this cohort, 2,419 patients were identified and stratified into two groups: high ABI (> 1.4; 2.6%) and normal ABI (1.0–1.4; 97.3%). The primary endpoint was the cumulative incidence of major adverse cardiovascular events (MACE), including cardiovascular-associated death, myocardial infarction, and stroke.ResultsCompared with the normal ABI group, patients in the high ABI group showed significantly lower body mass index (BMI) and hemoglobin level, but had higher incidence of chronic kidney disease and hemodialysis. Multivariate logistic regression analysis revealed that hemodialysis was the strongest predictor of high ABI (odds ratio, 6.18; 95% confidence interval (CI), 3.05–12.52; P < 0.001). During the follow-up (median, 4.7 years), 172 cases of MACE occurred. Cumulative MACE incidence in patients with high ABI was significantly increased compared to that in those with normal ABI (32.5% vs. 14.5%; P = 0.005). In traditional cardiovascular risk factors-adjusted multivariate Cox proportional hazard analysis, high ABI was an independent predictor of MACE (hazard ratio, 2.07; 95% CI, 1.02–4.20; P = 0.044).ConclusionLower BMI, chronic kidney disease, and hemodialysis are more frequent in patients with high ABI. Hemodialysis is the strongest predictor of high ABI. High ABI is a parameter that independently predicts MACE.

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Section: Discussionmentioning

confidence: 99%

Clinical Characteristics and Outcomes of Patients with High Ankle-Brachial Index from the IMPACT-ABI Study

et al. 2016

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“…The ankle‐brachial index was calculated as the average of the 2 resting ankle systolic pressure readings divided by the average of the 2 resting brachial systolic pressure readings. The correlation between the duplicate blood pressure readings has been described16 and was found to be 0.92 in the leg, and 0.90 in the arm. The mean difference between the duplicate readings was 0.5 mm Hg (95% confidence interval [CI]: 0.3–0.6) in the leg and 3.0 mm Hg (95% CI: 2.8–3.2) in the arm.…”

Section: Methodsmentioning

confidence: 93%

“…Details of ABI measurement in the ARIC study have been previously described 16, 17. Briefly, resting ankle and brachial pressures were measured by a standardized protocol using a DINAMAP™ 1846 SX automated oscillometric device (Critikon, Tampa, FL).…”

Section: Methodsmentioning

confidence: 99%

“…Details of ABI measurement in the ARIC study have been previously described. 16,17 Briefly, resting ankle and brachial pressures were measured by a standardized protocol using a DINAMAP TM 1846 SX automated oscillometric device (Critikon, Tampa, FL). Ankle blood pressure was measured with the individual in a prone position, in only one leg, which was selected based on the fifth digit of the ARIC ID.…”

Section: Abi Measurementmentioning

confidence: 99%

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Association of Peripheral Artery Disease With Incident Atrial Fibrillation: The ARIC (Atherosclerosis Risk in Communities) Study

Bekwelem

Norby

Agarwal

et al. 2018

JAHA

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BackgroundAlthough peripheral artery disease as defined by ankle‐brachial index (ABI) is associated with incident atrial fibrillation (AF), questions remain about the risk of AF in borderline ABI (>0.90 to <1.0) or noncompressible arteries (>1.4). We evaluated the association of borderline ABI and ABI >1.4 in the ARIC (Atherosclerosis Risk in Communities) study, a population‐based prospective cohort study.Methods and ResultsWe included 14 794 participants (age, 54.2±5.8 years, 55% women, 26% blacks) with ABI measured at the baseline (1987–1989) and without AF. AF was identified from hospital records, death certificates, and ECGs. Using Cox proportional hazards, we evaluated the association between ABI and AF. During a median follow‐up of 23.3 years, there were 2288 AF cases. After adjustment for cardiovascular risk factors, hazard ratio (HR) (95% confidence interval) for AF among individuals with ABI <1.0 compared with ABI 1.0 to 1.4, was 1.13 (1.01–1.27). ABI >1.4 was not associated with increased AF risk. ABI ≤0.9 and borderline ABI were associated with a higher risk of AF compared with ABI 1.0 to 1.4. Demographics‐adjusted HRs (95% confidence interval) were 1.43 (1.17–1.75) and 1.32 (1.16–1.50), respectively. However, the associations of ABI ≤0.9 and borderline ABI with AF were attenuated after adjusting for cardiovascular risk factors (HR [95% confidence interval], 1.10 [0.90–1.34] and 1.14 [1.00–1.30]), respectively.ConclusionsPeripheral artery disease indicated by low ABI, including borderline ABI, is a weak risk factor for AF. ABI >1.4 is not associated with an increased AF risk. The relationship between peripheral artery disease and AF appears to be mostly explained by traditional atherosclerotic risk factors.

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“…In contrast, smoking is related to lower prevalence of MAC or studies report a lack of association. 9–12,17,31 Although there is some heterogeneity, most studies report no relationship of hypertension or dyslipidemia with MAC. 8,11,17 For atherosclerotic calcification, such as predominant in the coronary arteries, traditional cardiovascular risk factors, including smoking and hyperlipidemia are associated with calcification.…”

Section: Discussionmentioning

confidence: 99%

Calcification of the splenic, iliac, and breast arteries and risk of all-cause and cardiovascular mortality

et al. 2017

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Background and aims CVD risks associated with coronary artery calcification (CAC) and aortic calcification (AC) are well known, but less is known about other calcified arteries. We aimed to assess the associations of arterial calcification in the breast, splenic, and internal and external iliac arteries with CVD risk factors and mortality. Methods We conducted a case-cohort study nested in a cohort of 5196 individuals who self-referred or were referred by a health care provider for whole body computed tomography (CT), including a random subcohort (n=395) and total and CVD mortality cases (n=298 and n=90), who died during a median follow-up of 9.4 years. Arterial calcification in the breast, splenic, and internal and external iliac arteries on CT was scored using a simple visual score. AC and CAC were previously measured using the Agatston technique. Logistic regression models were made to study associations of CVD risk factors with calcification in the different vascular beds. Prentice-weighted Cox proportional hazards models adjusted for CVD risk factors, and calcification in other vascular beds, were used to study associations with mortality. Results In the subcohort, the mean age was 56.6 years (SD 11.1) and 41.3% were female. The prevalence of calcification on CT, was 11.6% in the splenic, 47.9% in the internal iliac and 9.5% in the external iliac arteries, while 3.7% of women had breast artery calcification (BAC). Calcification in the splenic and iliac arteries was associated with calcification in the abdominal aorta but differentially associated with other CVD risk factors in logistic regression models. The prevalence of BAC was too low to fit these multivariable models. Calcification of the external iliac arteries was significantly associated with both all-cause and CVD mortality, but no longer significant when adjusted for CVD risk factors. Breast artery calcification was associated with both all-cause and CVD mortality independent of CVD risk factors and AAC and CAC (all-cause HR 5.67 [95% CI 1.50–21.41]). Conclusions Risk factors associated with calcification, and the association of calcification with risk of mortality differ across vascular beds, possibly reflecting different pathophysiology.

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Association of High Ankle Brachial Index With Incident Cardiovascular Disease and Mortality in a High-Risk Population

Cited by 48 publications

References 23 publications

Clinical Characteristics and Outcomes of Patients with High Ankle-Brachial Index from the IMPACT-ABI Study

Clinical Characteristics and Outcomes of Patients with High Ankle-Brachial Index from the IMPACT-ABI Study

Association of Peripheral Artery Disease With Incident Atrial Fibrillation: The ARIC (Atherosclerosis Risk in Communities) Study

Calcification of the splenic, iliac, and breast arteries and risk of all-cause and cardiovascular mortality

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