Costs and effects of cardiovascular risk reclassification using the ankle-brachial index (ABI) in addition to the Framingham risk scoring in women

Cortesi, P.; Maloberti, Alessandro; Micale, Mariangela; Pagliarin, Federica; Antonazzo, Ippazio Cosimo; Mazzaglia, Giampiero; Giannattasio, Cristina; Mantovani, Lorenzo Giovanni

doi:10.1016/j.atherosclerosis.2020.11.004

Cited by 6 publications

(7 citation statements)

References 44 publications

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“…While baPWV cost-effectiveness data is unavailable, data are available for ABI. A recent Markov model 54 focused on 10-year cardiovascular event risk among women in the general Italian population. The additional cost associated with ABI screening, when added to the Framingham Risk Score, was €110/patient, the incremental quality-adjusted life-year was 0.0039/patient, and the incremental cost-effectiveness ratio was €27.99/quality-adjusted life-years.…”

Section: Evidence Supporting Use Of Bapwv As a Vascular Biomarkermentioning

confidence: 99%

Reimagining the Value of Brachial-Ankle Pulse Wave Velocity as a Biomarker of Cardiovascular Disease Risk—A Call to Action on Behalf of VascAgeNet

et al. 2023

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This review critiques the literature supporting clinical assessment and management of cardiovascular disease and cardiovascular disease risk stratification with brachial-ankle pulse wave velocity (baPWV). First, we outline what baPWV actually measures—arterial stiffness of both large central elastic arteries and medium-sized muscular peripheral arteries of the lower limb. Second, we argue that baPWV is not a surrogate for carotid-femoral pulse wave velocity. While both measures are dependent on the properties of the aorta, baPWV is also strongly dependent on the muscular arteries of the lower extremities. Increased lower-extremity arterial stiffness amplifies and hastens wave reflections at the level of the aorta, widens pulse pressure, increases afterload, and reduces coronary perfusion. Third, we used an established evaluation framework to identify the value of baPWV as an independent vascular biomarker. There is sufficient evidence to support (1) proof of concept; (2) prospective validation; (3) incremental value; and (4) clinical utility. However, there is limited or no evidence to support (5) clinical outcomes; (6) cost-effectiveness; (7) methodological consensus; or (8) reference values. Fourth, we address future research requirements. The majority of the evaluation criteria ([1] proof of concept, [2] prospective validation, [3] incremental value, [4] clinical utility, and [9] reference values) can be supported using existing cohort datasets, whereas the (5) clinical outcomes and (6) cost-effectiveness criteria require prospective investigation. The (8) methodological consensus criteria will require an expert consensus statement. Finally, we finish this review by providing an example of a future clinical practice model.

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Section: Evidence Supporting Use Of Bapwv As a Vascular Biomarkermentioning

confidence: 99%

Reimagining the Value of Brachial-Ankle Pulse Wave Velocity as a Biomarker of Cardiovascular Disease Risk—A Call to Action on Behalf of VascAgeNet

et al. 2023

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“…Ankle-brachial index (ABI) will be measured in the supine position on the upper and lower extremities with a fully automated system. ABI is a strong predictor of macrovascular events and its inclusion was shown to improve the performance and cost-effectiveness of the Framingham Risk Score (FRS) [ 113 , 114 ].…”

Section: Methodsmentioning

confidence: 99%

The Semmelweis Study: a longitudinal occupational cohort study within the framework of the Semmelweis Caring University Model Program for supporting healthy aging

Ungvari,

Tabák,

Adany

et al. 2023

GeroScience

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The Semmelweis Study is a prospective occupational cohort study that seeks to enroll all employees of Semmelweis University (Budapest, Hungary) aged 25 years and older, with a population of 8866 people, 70.5% of whom are women. The study builds on the successful experiences of the Whitehall II study and aims to investigate the complex relationships between lifestyle, environmental, and occupational risk factors, and the development and progression of chronic age-associated diseases. An important goal of the Semmelweis Study is to identify groups of people who are aging unsuccessfully and therefore have an increased risk of developing age-associated diseases. To achieve this, the study takes a multidisciplinary approach, collecting economic, social, psychological, cognitive, health, and biological data. The Semmelweis Study comprises a baseline data collection with open healthcare data linkage, followed by repeated data collection waves every 5 years. Data are collected through computer-assisted self-completed questionnaires, followed by a physical health examination, physiological measurements, and the assessment of biomarkers. This article provides a comprehensive overview of the Semmelweis Study, including its origin, context, objectives, design, relevance, and expected contributions.

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“…2,3 The advantage of ABI is the simplicity and affordability of the method. 4 Therefore its use is feasible worldwide in medical facilities. 5 There is general consensus, that ABI values of 0.9-1.3 are considered normal, although a single measurement does not rule out substantial LEAD.…”

Section: Introductionmentioning

confidence: 99%

“…2,3 The advantage of ABI is the simplicity and affordability of the method. 4 Therefore its use is feasible worldwide in medical facilities. 5…”

Section: Introductionmentioning

confidence: 99%

Incompressible ankle arteries predict increased morbidity and mortality in patients with an elevated ankle brachial index

et al. 2022

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Objectives Patients with an elevated ankle brachial index (ABI) > 1.3 have a high burden of disease and poorer outcome compared to patients with a lower ABI. Previously differences between patients with ABI > 1.3 have not been studied in detail. The aim of this study was to analyze the morbidity and mortality of patients with ABI > 1.3. Methods ABI measurements were performed in the vascular laboratory of Turku university hospital 2011–2013. Patients with ABI>1.3 in at least one lower limb were included in the study and divided into 3 groups: At least one lower limb ABI 1.3–2.5 but both limbs <2.5 (group 1), one limb ABI ≥2.5 (group 2), both limbs ABI ≥ 2.5 (group 3). Results 534 patients were included in the study. The patients in groups 2 and 3 were more often female ( p < .001), older ( p < .001), had more diabetes ( p = .013), coronary artery disease ( p = .001) and chronic heart ( p = .010) and kidney failure ( p = .013) compared to patients in group 1. The survival of patients in group 2 and 3 was significantly poorer compared to the patients in group 1 (HR1.6, 95% CI 1.2–2.2, p = .002 and 1.7, 95% CI 1.2–2.3, p < .001, respectively). Overall and cardiovascular mortality was higher in groups 2 and 3 than group 1.39.5% of patients with incompressible ankle arteries (ABI ≥ 2.5) in both lower limbs had toe pressure (TP) <50 mmHg and a poorer survival compared to patients with a higher TP. Conclusions Patients with incompressible ankle arteries have significantly higher overall and cardiovascular mortality and a greater burden of disease compared to the patients with a measurable yet abnormally high ABI. TP is a useful diagnostic tool when ABI is immeasurably high. All patients with ABI > 1.3 should be considered as high cardiovascular risk patients.

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Costs and effects of cardiovascular risk reclassification using the ankle-brachial index (ABI) in addition to the Framingham risk scoring in women

Cited by 6 publications

References 44 publications

Reimagining the Value of Brachial-Ankle Pulse Wave Velocity as a Biomarker of Cardiovascular Disease Risk—A Call to Action on Behalf of VascAgeNet

Reimagining the Value of Brachial-Ankle Pulse Wave Velocity as a Biomarker of Cardiovascular Disease Risk—A Call to Action on Behalf of VascAgeNet

The Semmelweis Study: a longitudinal occupational cohort study within the framework of the Semmelweis Caring University Model Program for supporting healthy aging

Incompressible ankle arteries predict increased morbidity and mortality in patients with an elevated ankle brachial index

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