Low, borderline and normal ankle-brachial index as a predictor of incidents outcomes in the Mediterranean based-population ARTPER cohort after 9 years follow-up

Alzamora, María Teresa; Forés, Rosa; Pera, Guillem; Baena-Díez, José Miguel; Valverde, Marta

doi:10.1371/journal.pone.0209163

Cited by 8 publications

(12 citation statements)

References 25 publications

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“…Recently, borderline ABI has become accepted as a concept that refers to values between 0.90 and 0.99. Many cohort studies suggest that borderline ABI seems to be associated with increased cardiovascular morbidity and mortality [ 15 , 16 , 17 , 21 ] in comparison to the normal ABI range of 1.00–1.40. An IMPACT-ABI study on symptomatic peripheral arterial disease (PAD) patients demonstrated that even a 10% higher MACE at 4 years and cardiovascular death [ 17 ] among the borderline ABI group compared to ABI range category 1.00–1.40 is in line with the findings of an ARTPER cohort study with a 9-year follow-up.…”

Section: Discussionmentioning

confidence: 99%

The Cardiovascular-Mortality-Based Estimate for Normal Range of the Ankle–Brachial Index (ABI)

Peltonen

Laivuori

Vakhitov

et al. 2022

JCDD

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Background: The ankle–brachial index (ABI) is a first-line examination in cardiovascular risk evaluation. Since cut-off values for normal ABI vary, the aim of the present study was to identify the cardiovascular-mortality-based estimate for the normal range of the ABI. After determining the reference range for the ABI, the corresponding toe–brachial index (TBI) and toe pressure for normal ABI were analyzed. Methods: All consecutive non-invasive pressure measurements in the vascular laboratory of a large university hospital 2011–2013 inclusive were collected and combined with patient characteristics and official dates and causes of death. Patients with an ABI range of 0.8–1.4 on both lower limbs were included in this study. Results: From 2751 patients, 868 had bilateral ABI values within the inclusion. Both ABI category ranges 0.80–0.89 and 0.90–0.99 had poorer survival compared to ABI categories 1.00–1.29 (p < 0.05). The 1-, 3-, and 5-year cardiovascular-death-free survival for respective ABI categories 0.80–0.99 vs. 1.00–1.29 were 90% vs. 96%, 84% vs. 92%, and 60% vs. 87%. The 1-, 3-, and 5-year overall survival for ABI categories 0.80–0.99 vs. 1.00–1.29 were 85% vs. 92%, 75% vs. 83%, and 42% vs. 74%. Conclusions: Borderline ABI (0.90–0.99) associates with higher overall and cardiovascular mortality compared to ABI values 1.00–1.29.

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Section: Discussionmentioning

confidence: 99%

The Cardiovascular-Mortality-Based Estimate for Normal Range of the Ankle–Brachial Index (ABI)

Peltonen

Laivuori

Vakhitov

et al. 2022

JCDD

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“…These included high-risk patients diagnosed with cardiovascular (CVD) disease [ 18 ], burdened with CVD risks factors [ 11 ], symptomatic and asymptomatic PAD [ 9 , 12 , 17 ], and diabetes mellitus [ 13 , 15 , 18 ]. The risk was demonstrated in the primary care setting [ 10 , 13 ], and in population-based studies [ 4 , 5 , 8 , 16 – 19 ], alike. This was further confirmed in systematic reviews and meta-analyses [ 16 , 28 , 29 ].…”

Section: Discussionmentioning

confidence: 99%

“…Ankle-brachial index (ABI) 0.9 has been used to diagnose peripheral arterial disease (PAD), even at the pre-clinical stage [1]. Low ABI is associated with atherosclerosis of coronary and carotid arteries [2][3][4][5][6], and increased all-cause and cardiovascular mortality [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. ABI of more than 1.4, an index of arterial stiffness, has also been associated with adverse outcome, especially in older subjects [8,20,21].…”

Section: Introductionmentioning

confidence: 99%

Disparate effects of ankle-brachial index on mortality in the ‘very old’ and ‘younger old’ populations-the PolSenior survey

et al. 2021

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To assess the relationship between ankle-brachial index (ABI) and up to 10-year mortality in older individuals below and above the age of 80 years. In a multicenter survey of health status in the community dwelling subjects aged 55–59 and 65 + years in Poland, we assessed baseline medical history including risk-factors. We measured ABI, and serum creatinine, cholesterol, NT-proBNP, and interleukin-6 (IL-6) concentrations. We assessed mortality based on public registry. Between 2009 and 2019, 27.3% of 561 participants < 80 years, and 79.4% of 291 participants ≥ 80 years, died (p < 0.001); 67.8, 41.5, and 40.3% in the ABI groups < 0.9, 0.9–1.4, and > 1.4, respectively (p < 0.01). In the unadjusted Cox models, ABI was associated with mortality in the entire group, and < 80 years. In the entire group, analysis adjusted for age and sex showed mortality risk increased by 11% per year, and 50% with male sex. Mortality decreased by 37% per 1 unit ABI increase. In the group of people ≥ 80 years, only age was significantly associated with mortality (p < 0.001). In stepwise regression ABI < 0.9, male sex, active smoking, and NT-proBNP level were associated with risk of death < 80 years. In the ≥ 80 years old, mortality risk was associated with older age, and higher levels of IL-6, but not ABI. The ABI < 0.9 is associated with higher mortality in older people, but not among the oldest-old. In the oldest age group, age is the strongest predictor of death. In this age group, inflammageing is of importance.

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“…Until now, the ARTPER population-based cohort with low cardiovascular risk has been used to evaluate the incidence of vascular events, improvements made to the reclassification of cardiovascular risk scales following the addition of the ABI, as well as low, borderline, and normal ABI as a predictor of incidents events [ 21 , 22 , 23 ]. This study is focused on prevalent and incident cardiovascular outcomes and their relationship with ABI to evaluate the recurrence of cardiovascular events in a general population over the age of 49.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Morbidity and Mortality after First and Recurrent Cardiovascular Events in the ARTPER Cohort

Peris

Alzamora

Valverde

et al. 2020

JCM

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Background: Cardiovascular events are a major cause of mortality and morbidity worldwide. The risk of recurrence after a first cardiovascular event has been documented in the international literature, although not as extensively in a Mediterranean population-based cohort with low cardiovascular risk. There is also ample, albeit contradictory, research on the recurrence of stroke and myocardial infarctions (MI) after a first event and the factors associated with such recurrence, including the role of pathological Ankle-Brachial Index (ABI). Methods: The Peripheral Arterial ARTPER study is aimed at deepening our knowledge of patient evolution after a first cardiovascular event in a Mediterranean population with low cardiovascular risk treated at a primary care centre. We study overall recurrence, cardiac and cerebral recurrence. We studied participants in the ARTPER prospective observational cohort, excluding patients without cardiovascular events or with unconfirmed events and patients who presented arterial calcification at baseline or who died. In total, we analyzed 520 people with at least one cardiovascular event, focusing on the presence and type of recurrence, the risk factors associated with recurrence and the behavior of the ankle-brachial index (ABI) as a predictor of risk. Results: Between 2006 and 2017, 46% of patients with a first cardiovascular event experienced a recurrence of some type; most recurrences fell within the same category as the first event. The risk of recurrence after an MI was greater than after a stroke. In our study, recurrence increased with age, the presence of peripheral arterial disease (PAD), diabetes and the use of antiplatelets. Diabetes mellitus was associated with all types of recurrence. Additionally, patients with an ABI < 0.9 presented more recurrences than those with an ABI ≥ 0.9. Conclusions: In short, following a cardiac event, recurrence usually takes the form of another cardiac event. However, after having a stroke, the chance of having another stroke or having a cardiac event is similar. Lastly, ABI < 0.9 may be considered a predictor of recurrence risk.

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Low, borderline and normal ankle-brachial index as a predictor of incidents outcomes in the Mediterranean based-population ARTPER cohort after 9 years follow-up

Cited by 8 publications

References 25 publications

The Cardiovascular-Mortality-Based Estimate for Normal Range of the Ankle–Brachial Index (ABI)

The Cardiovascular-Mortality-Based Estimate for Normal Range of the Ankle–Brachial Index (ABI)

Disparate effects of ankle-brachial index on mortality in the ‘very old’ and ‘younger old’ populations-the PolSenior survey

Long-Term Morbidity and Mortality after First and Recurrent Cardiovascular Events in the ARTPER Cohort

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