Mortality and Cardiovascular Risk Across the Ankle-Arm Index Spectrum Results From the Cardiovascular Health Study

University of Pittsburgh, Pittsburgh, Pennsylvania, United States
Circulation (Impact Factor: 14.95). 01/2006; 113(3):388-93. DOI: 10.1161/CIRCULATIONAHA.105.570903
Source: PubMed

ABSTRACT A low ankle-arm index (AAI) is a strong predictor of mortality and cardiovascular events. A high AAI also appears to be associated with higher mortality risk in select populations. However, mortality and cardiovascular risk across the AAI spectrum have not been described in a more broadly defined population.
We examined total and cardiovascular mortality and cardiovascular events across the AAI spectrum among 5748 participants in the Cardiovascular Health Study (CHS). The mean age of the sample population was 73+/-6 years, and the sample included 3289 women (57%) and 883 blacks (15%). The median duration of follow-up was 11.1 (0.1 to 12) years for mortality and 9.6 (0.1 to 12.1) years for cardiovascular events. There were 2311 deaths (953 of which were cardiovascular) and 1491 cardiovascular events during follow-up. After adjustment for potential confounders, AAI measurements < or =0.60 (hazard ratio [HR] 1.82, 95% CI 1.42 to 2.32), 0.61 to 0.7 (HR 2.08, 95% CI 1.61 to 2.69), 0.71 to 0.8 (HR 1.80, 95% CI 1.44 to 2.26), 0.81 to 0.9 (HR 1.73 95% CI 1.43 to 2.11), 0.91 to 1.0 (HR 1.40, 95% CI 1.20 to 1.63), and >1.40 (HR 1.57, 95% CI 1.07 to 2.31) were associated with higher mortality risk from all causes compared with the referent group (AAI 1.11 to 1.20). The pattern was similar for cardiovascular mortality. For cardiovascular events, risk was higher at all AAI levels <1 but not for AAI levels >1.4 (HR 1.00, 95% CI 0.57 to 1.74). The association of a high AAI with mortality was stronger in men than in women and in younger than in older cohort members.
In a cohort of community-dwelling elders, mortality risk was higher than the referent category of 1.11 to 1.2 among participants with AAI values above the traditional cutpoint of 0.9 (ie, 0.91 to 1.0 and >1.4), and the specific association of AAI with mortality varied by age and gender.

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    • "Borderline ABI (0.90e0.99) does not meet the diagnostic threshold for PAD, but is associated with an increased risk of cardiovascular mortality [6] and functional decline [20]. Low ABI (<0.90) is the diagnostic criteria for PAD, is sensitive and specific to PAD diagnosed by angiography [19], and is associated with an even higher cardiovascular risk [6]. No participants had an ABI>1.4 at either assessment visit. "
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    ABSTRACT: Though being physically active has associated with a healthier ankle-brachial index (ABI) in observational studies, ABI usually does not change with exercise training in patients with peripheral artery disease (PAD). Less is known about the effect of exercise training on ABI in patients without PAD but at high risk due to the presence of type 2 diabetes (T2DM). Participants (n = 140) with uncomplicated T2DM, and without known cardiovascular disease or PAD, aged 40-65 years, were randomized to supervised aerobic and resistance training 3 times per week for 6 months or to a usual care control group. ABI was measured before and after the intervention. Baseline ABI was 1.02 ± 0.02 in exercisers and 1.03 ± 0.01 in controls (p = 0.57). At 6 months, exercisers vs. controls improved ABI by 0.04 ± 0.02 vs. -0.03 ± 0.02 (p = 0.001). This change was driven by an increase in ankle pressures (p < 0.01) with no change in brachial pressures (p = 0.747). In subgroup analysis, ABI increased in exercisers vs. controls among those with baseline ABI <1.0 (0.14 ± 0.03 vs. 0.02 ± 0.02, p = 0.004), but not in those with a baseline ABI ≥1.0 (p = 0.085). The prevalence of ABI between 1.0 and 1.3 increased from 63% to 78% in exercisers and decreased from 62% to 53% in controls. Increased ABI correlated with decreased HbA1c, systolic and diastolic blood pressure, but the effect of exercise on ABI change remained significant after adjustment for these changes (β = 0.061, p = 0.004). These data suggest a possible role for exercise training in the prevention or delay of PAD in T2DM, particularly among those starting with an ABI <1.0. Registry Number: NCT00212303.
    Atherosclerosis 09/2013; 230(1):125-30. DOI:10.1016/j.atherosclerosis.2013.07.002 · 3.97 Impact Factor
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    • " 2 . 09 , very similar to that reported in low ABI ( PAD ) patients ( 1 . 69 and 2 . 52 , respectively ) ( Resnick et al . , 2004 ) . An examination of data from the Cardiovascular Health Study ( CHS ) found an increased hazard ratio in high - ABI patients ( HR = 1 . 57 ) for all mortality causes and CVD mortality , however not for CV events ( O ' Hare et al . , 2006 ) . With regard to risk factor impact , the ARIC Study highlighted that in patients with high - ABI ( ABI > 1 . 3 , prevalence 5 . 5% ; ABI > 1 . 4 , prevalence 1 . 2% ) , there was a greater BMI , but a lower prevalence of hypertension and smoke ( and also fewer packs smoked per year ) when compared to controls . Furthermore , no signi"
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    ABSTRACT: Many studies have been carried out to assess the prevalence, risk factors and co-morbidities of peripheral artery disease (PAD). By contrast, to date there is a lack of data on patients with high-ABI. This study aimed at estimating the prevalence of increased ABI (ABI>1.4) and to evaluate the involvement of traditional cardiovascular (CV) risk factors and the atherosclerotic burden (peripheral and carotid arteries) of these patients in a population of Southern Italy. We invited 9647 subjects, age ranging from 30 to 80, by letters to undergo an ABI measurement. Consequently, in patients with ABI>1.4, an ultrasound evaluation of the peripheral and carotid arteries was performed. An ABI>1.4 was found in 260 of 3412 subjects (7.6%). Statistically significant differences were reported in age, diabetes and hypertension, body mass index (BMI) and waist circumference (WC). No differences in sex distribution, dyslipidemia and smoke prevalence were observed. Moreover, 67.9% of ABI>1.4 patients showed a peripheral intima-media thickness (IMT)>0.9 mm; at linear regression it was correlated with ABI values; 25% of patients showed peripheral plaques. A carotid IMT>0.9 mm was reported in 78.6% of high-ABI patients and 32.1% were affected by atherosclerotic plaques. The observed increased-ABI prevalence of 7.6% was higher than previously reported. This was more prevalent in an older population with diabetes, hypertension and obesity. Moreover, these patients are characterized by an extended atherosclerotic involvement. Further studies are needed to clarify this evidence, a longitudinal observation of this clinical outcome, as we are performing, could provide a number of interesting elements.
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    ABSTRACT: An epidemiologic study in Germany found that the overall prevalence of PAD in patients over 65 years was 20% in men and 17% in women. 4 A community-based survey of the prevalence of PAD in primary physicians' offi ces in the United States found that of patients who were between the ages of 50 and 69 years who had diabetes mellitus or smoked cigarettes or who were over 70 years, 29% had PAD. 5 The prevalence of intermittent claudication ranges from 1 to 5%. 1,2 The peak incidence of claudication occurs between the sixth and seventh decades and develops later in women than in men. Each year, approximately 2 to 4% of all patients with intermittent claudication develop critical limb ischemia. Long-term survival is reduced in patients with PAD. The risk of death in populations with peripheral atheroscle- rosis is increased twofold to fourfold.
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