The Relationship between Ankle‐Arm Index and Mortality in Older Men and Women

Vogt, Molly T.; McKenna, Matthew T.; Anderson, Stewart J.; Wolfson, Sidney K.; Kuller, Lewis H.

doi:10.1111/j.1532-5415.1993.tb01889.x

Cited by 121 publications

(70 citation statements)

References 35 publications

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“…[11][12][13]25 An ABI Յ0.9 has been consistently associated with a 2-to 5-fold increase in all-cause death and a 3-to 8-fold increase in cardiovascular death when compared with an ABI Ͼ0.9. [11][12][13]26 However, there are still some issues to be addressed about the use of the ABI as a diagnostic tool. First, there is limited research on how the risk of vascular events varies across the whole range of ABI in the general population.…”

Section: Discussionmentioning

confidence: 99%

“…Cohort studies with between 5 and 10 years of follow-up have shown that people with a low ABI have an increased risk of both cardiovascular morbidity 10 and mortality. [11][12][13] We have previously reported that the 5-year incidence of total cardiovascular events in subjects with an ABI Յ0.9 was almost twice that in subjects with an ABI Ͼ0.9. 10 Furthermore, examination of positive predictive values showed that a low ABI was better at predicting risk of future cardiovascular and cerebrovascular events than conventional risk factors alone.…”

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confidence: 99%

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Improved Prediction of Fatal Myocardial Infarction Using the Ankle Brachial Index in Addition to Conventional Risk Factors

et al. 2004

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Background-Prediction of major cardiovascular and cerebrovascular events using conventional risk factor models is limited. Noninvasive measures of subclinical atherosclerosis such as the ankle brachial index (ABI) could improve risk prediction and provide more focused primary prevention strategies. We wished to determine the added value of a low ABI in the prediction of long-term risk of cardiovascular and cerebrovascular events and death. Methods and Results-In 1988, 1592 men and women 55 to 74 years of age were randomly selected from the age-sex registers of 11 general practices in Edinburgh, Scotland, and followed up over a period of 12 years for incident events. After adjustment for age and sex, an ABI Յ0.9 was predictive of an increased risk of fatal myocardial infarction (MI), cardiovascular death, all-cause death, combined fatal and nonfatal MI, and total cardiovascular events. After further adjustment for prevalent cardiovascular disease, diabetes, and conventional risk factors, a low ABI was independently predictive of the risk of fatal MI. Addition of the ABI significantly (PՅ0.01) increased the predictive value of the model for fatal MI compared with a model containing risk factors alone. Comparison of areas under receiver operator characteristic curves confirmed that a model including the ABI discriminated marginally better than one without. Conclusions-Addition of the ABI significantly improved prediction of fatal MI over and above that of conventional risk factors. We recommend that the ABI be incorporated into routine cardiovascular screening and that the potential of its inclusion into cardiovascular scoring systems (with a view to improving their accuracy) now be examined.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Improved Prediction of Fatal Myocardial Infarction Using the Ankle Brachial Index in Addition to Conventional Risk Factors

et al. 2004

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“…22,23 An ABI of Ͻ0.90 is 95% sensitive and 99% specific for angiographically documented PAD. 24,25 This cutpoint has been related to prevalent and incident CVD and all-cause mortality in several studies 1,2,5,7,8 and has been used in other studies of American Indians 26 and in previous work in the SHS. 3 Participants who had an ABI Ͻ0.90 in either leg were categorized as having low ABI.…”

Section: Definition Of Abi Categoriesmentioning

confidence: 99%

Relationship of High and Low Ankle Brachial Index to All-Cause and Cardiovascular Disease Mortality

et al. 2004

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Background-The associations of low (Ͻ0.90) and high (Ͼ1.40) ankle brachial index (ABI) with risk of all-cause and cardiovascular disease (CVD) mortality have not been examined in a population-based setting. Methods and Results-We examined all-cause and CVD mortality in relation to low and high ABI in 4393 American Indians in the Strong Heart Study. Participants had bilateral ABI measurements at baseline and were followed up for 8.3Ϯ2.2 years (36 589 person-years). Cox regression was used to quantify mortality rates among participants with high and low ABI relative to those with normal ABI (0.90 ՅABI Յ1.40). Death from all causes occurred in 1022 participants (23.3%; 27.9 deaths per 1000 person-years), and of these, 272 (26.6%; 7.4 deaths per 1000 person-years) were attributable to CVD. Low ABI was present in 216 participants (4.9%), and high ABI occurred in 404 (9.2%). Diabetes, albuminuria, and hypertension occurred with greater frequency among persons with low (60.2%, 44.4%, and 50.1%) and high (67.8%, 49.9%, and 45.1%) ABI compared with those with normal ABI (44.4%, 26.9%, and 36.5%), respectively (PϽ0.0001). Adjusted risk estimates for all-cause mortality were 1.69 (1.34 to 2.14) for low and 1.77 (1.48 to 2.13) for high ABI, and estimates for CVD mortality were 2.52 (1.74 to 3.64) for low and 2.09 (1.49 to 2.94) for high ABI. Conclusions-The association between high ABI and mortality was similar to that of low ABI and mortality, highlighting a U-shaped association between this noninvasive measure of peripheral arterial disease and mortality risk. Our data suggest that the upper limit of normal ABI should not exceed 1.40.

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“…An ankle-brachial index (ABI) <1.00 is therefore abnormal, although a cut off <0.90 or <0.95 has greater specificity and is used to make the diagnosis of peripheral arterial disease (PAD) in the clinical setting. ABI is a simple, noninvasive method used to assess the presence and extent of PAD [2], and prospective studies have shown that a low ABI predicts fatal and non fatal coronary heart disease (CHD) and all cause mortality [3][4][5][6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Aortic augmentation index is associated with the ankle-brachial index: A community-based study

Khaleghi

Kullo

2007

Atherosclerosis

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Background-Increased arterial stiffness has been associated with greater risk of cardiovascular events. We investigated whether aortic augmentation index (AIx), a measure of arterial stiffness and wave reflection, was associated with the ankle-brachial index (ABI), a measure of peripheral arterial disease (PAD).Method-AIx and ABI were measured in a community-based sample of 475 adults without prior history of heart attack or stroke (mean age 59.3 years, 46.5% men). Radial artery pulse waveforms were obtained by applanation tonometry and an ascending aortic pressure waveform derived by a transfer function. AIx is the difference between the first and second systolic peak of the ascending aortic pressure waveform indexed to the central pulse pressure. ABI was measured using a standard protocol, and subjects with non-compressible vessels (ABI >1.5) were excluded from the analyses. Multivariable linear and logistic generalized estimating equations (GEE) analyses were used to assess whether AIx was associated with ABI and ABI <1.00 respectively, independent of conventional risk factors.Results-Mean (± SD) values were: AIx, 29.3±11.6 %; ABI, 1.12±0.13; 59 (12.4%) participants had an ABI <1.00. Variables associated with a lower ABI (and ABI <1.00) included older age, shorter height, female sex, higher total cholesterol, hypertension medication use, history of smoking, and higher AIx. After adjustment for mean arterial pressure and the above variables, higher AIx remained associated with a lower ABI (P=0.015) and ABI <1.00 (P=0.002). A significant interaction (P=0.007) was present between AIx and age in the prediction of ABI; the (inverse) association of AIx with ABI was stronger in older subjects (>65 years).Conclusion-AIx, a measure of arterial stiffness and wave reflection, was independently associated with a lower ABI in asymptomatic subjects from the community, and this association was modified by age.

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The Relationship between Ankle‐Arm Index and Mortality in Older Men and Women

Cited by 121 publications

References 35 publications

Improved Prediction of Fatal Myocardial Infarction Using the Ankle Brachial Index in Addition to Conventional Risk Factors

Improved Prediction of Fatal Myocardial Infarction Using the Ankle Brachial Index in Addition to Conventional Risk Factors

Relationship of High and Low Ankle Brachial Index to All-Cause and Cardiovascular Disease Mortality

Aortic augmentation index is associated with the ankle-brachial index: A community-based study

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