Abstract
Background
Ankle brachial index (ABI) as a risk-enhancing factor in addition to the pooled cohort
equation (PCE) in assessing cardiovascular risk for primary prevention of atherosclerotic
cardiovascular disease (ASCVD) is uncertain.
Methods
We analyzed data from the 1999-2004 National Health and Nutrition Examination Survey
(NHANES), for 5130 participants, aged 40 and older, without known cardiovascular disease
or diabetes, with available data on standard ASCVD risk and ABI. Prevalence of low
ABI (ABI<0.9) and all-cause mortality in persons with low, borderline and intermediate
ASCVD risk categories using PCE was assessed.
Results
The overall prevalence of low ABI was 3.1%. The participants with low ABI were predominantly
clustered in the intermediate (33%) and high (33%) ASCVD risk categories while most
participants with a normal ABI were in the low (56%) and intermediate (23%) risk categories.
All-cause mortality was higher among participants with low ABI compared to those with
a normal ABI in both the intermediate/borderline and high-risk categories, p<0.001
but not in the low-risk ASCVD category, p= 0.323.
Conclusions
Using the PCE, two-third of the participants with low ABI were classified as having
a low, borderline or intermediate risk of ASCVD. Low ABI was associated with an increased
all-cause mortality in the overall cohort and specifically among those with a borderline/intermediate
or high risk of ASCVD but not in those with a low risk of ASCVD. Our study supports
consideration of ABI as a risk enhancer for primary prevention among patients classified
as borderline or intermediate risk of ASCVD.
Keywords
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References
- Heart Disease and Stroke Statistics—2020 Update: A Report From the American Heart Association.Circulation. 2020; 141https://doi.org/10.1161/CIR.0000000000000757
- 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.Circulation. 2019; 140: e596-e646https://doi.org/10.1161/CIR.0000000000000678
- Association of low ankle brachial index with high mortality in primary care.Eur Heart J. 2006; 27: 1743-1749https://doi.org/10.1093/eurheartj/ehl092
- NHANES Survey Methods and Analytic Guidelines n.d.2020 (accessed March 7)
- 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk.Circulation. 2014; 129: S49-S73https://doi.org/10.1161/01.cir.0000437741.48606.98
- Mortality over a period of 10 years in patients with peripheral arterial disease.N Engl J Med. 1992; 326: 381-386https://doi.org/10.1056/NEJM199202063260605
Center for Health Statistics N. The Linkage of National Center for Health Statistics Survey Data to the National Death Index –2015 Linked Mortality File (LMF): Methodology Overview and Analytic Considerations. n.d.
- 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol.J Am Coll Cardiol. 2019; 73: e285-e350https://doi.org/10.1016/j.jacc.2018.11.003
- Screening for peripheral artery disease and cardiovascular disease risk assessment with the ankle-brachial index in adults: U.S. Preventive Services Task Force recommendation statement.Ann Intern Med. 2013; 159: 342-348https://doi.org/10.7326/0003-4819-159-5-201309030-00008
- Ankle brachial index combined with Framingham Risk Score to predict cardiovascular events and mortality: a meta-analysis.JAMA. 2008; 300: 197-208https://doi.org/10.1001/jama.300.2.197
- Utility of Nontraditional Risk Markers in Atherosclerotic Cardiovascular Disease Risk Assessment.J Am Coll Cardiol. 2016; 67: 139-147https://doi.org/10.1016/j.jacc.2015.10.058
- Ankle-brachial index and cardiovascular risk prediction: an analysis of 11,594 individuals with 10-year follow-up.Atherosclerosis. 2012; 220: 160-167https://doi.org/10.1016/j.atherosclerosis.2011.10.037
- Use of ankle brachial pressure index to predict cardiovascular events and death: a cohort study.BMJ. 1996; 313: 1440-1444https://doi.org/10.1136/bmj.313.7070.1440
- Relationship of high and low ankle brachial index to all-cause and cardiovascular disease mortality: the Strong Heart Study.Circulation. 2004; 109: 733-739https://doi.org/10.1161/01.CIR.0000112642.63927.54
- The association of the ankle-brachial index with incident coronary heart disease: the Atherosclerosis Risk In Communities (ARIC) study, 1987-2001.BMC Cardiovasc Disord. 2007; 7: 3https://doi.org/10.1186/1471-2261-7-3
- Validation of the Atherosclerotic Cardiovascular Disease Pooled Cohort Risk Equations.JAMA. 2014; : 311https://doi.org/10.1001/jama.2014.2630
- Utility and barriers to performance of the ankle-brachial index in primary care practice.Vasc Med. 2004; 9: 253-260https://doi.org/10.1191/1358863x04vm559oa
- Peripheral arterial disease, prevalence and cumulative risk factor profile analysis.Eur J Prev Cardiol. 2014; 21: 704-711https://doi.org/10.1177/2047487312452968
- Aspirin for prevention of cardiovascular events in a general population screened for a low ankle brachial index: a randomized controlled trial.JAMA. 2010; 303: 841-848https://doi.org/10.1001/jama.2010.221
- Population screening and intervention for vascular disease in Danish men (VIVA): a randomised controlled trial.Lancet. 2017; 390 (London, England): 2256-2265https://doi.org/10.1016/S0140-6736(17)32250-X
Article Info
Publication History
Accepted:
August 9,
2022
Received in revised form:
June 20,
2022
Received:
September 29,
2021
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Published by Elsevier Inc. on behalf of Southern Society for Clinical Investigation.
