The ratio of ankle and arm arterial pressure as an independent predictor of mortality.

We carefully ascertained deaths for a cohort of 744 patients who had undergone noninvasive testing for lower extremity peripheral arterial disease (PAD) in a university affiliated, community hospital. Using a ratio of the ankle and brachial blood pressures (ABI) of less than 0.85 as the criteria, the relative risk (RR) for total mortality associated with PAD was 2.36 (95% CL = 1.60, 3.48) after adjusting for baseline covariates in a proportional hazards model. There was a strong trend for increasing risk with decreasing ABI (P less than 0.0001). Specific causes of death for which survival was directly related to the magnitude of ABI were myocardial infarctions, and deaths other than vascular disease and cancer. There was no relationship between ABI and the risk of mortality from cancer. The mortality experience of those with normal ABI was very similar to that of the general U.S. population (age adjusted RR = 1.14, 95% CL = 0.78, 1.61), whereas the risk for those with an ABI less than 0.4 was markedly elevated in comparison to the U.S. population (RR = 4.49, 95% CL = 3.52, 5.64). Our results suggest that the relatively technically simple measure of the ratio of ankle to brachial blood pressures, if low, carries a very poor prognosis and should prompt investigation and treatment of atherosclerotic disease in other vascular systems.

[1]  J. Mann,et al.  Intermittent claudication: prevalence and risk factors. , 1978, British medical journal.

[2]  A. Boyd.  The natural course of arteriosclerosis of the lower extremities. , 1962 .

[3]  W. O'Fallon,et al.  A prospective study of peripheral occlusive arterial disease in diabetes. II. Vascular laboratory assessment. , 1981, Mayo Clinic proceedings.

[4]  E. Agner,et al.  Natural history of angina pectoris, possible previous myocardial infarction and intermittent claudication during the eighth decade. A longitudinal epidemiologic study. , 2009, Acta medica Scandinavica.

[5]  David R. Cox,et al.  Regression models and life tables (with discussion , 1972 .

[6]  E. Barrett-Connor,et al.  TABLE 1 Prevalence of PAD by traditional assessment : intermittent claudication and pulse palpation % Claudication % Pulse abnormalities Rose Femoral Posterior Dorsalis n Rose , 2005 .

[7]  L. Kuller,et al.  Marked decline of coronary heart disease mortality in 35-44-year-old white men in Allegheny County, Pennsylvania. , 1989, Circulation.

[8]  K. Beach,et al.  Prevalence of Severe Arteriosclerosis Obliterans in Patients with Diabetes Mellitus: Relation to Smoking and Form of Therapy , 1982, Arteriosclerosis.

[9]  N. E. Breslow.  Statistical Methods in Cancer Research , 1986 .

[10]  M. Shipley,et al.  Plasma cholesterol concentration and death from coronary heart disease: 10 year results of the Whitehall study. , 1986, British medical journal.

[11]  S. Coughlin,et al.  Noninvasively diagnosed peripheral arterial disease as a predictor of mortality: results from a prospective study. , 1985, Circulation.

[12]  A. Fronek,et al.  Current status of noninvasive tests in the diagnosis of peripheral arterial disease. , 1982, The Surgical clinics of North America.

[13]  E. Barrett-Connor,et al.  The sensitivity, specificity, and predictive value of traditional clinical evaluation of peripheral arterial disease: results from noninvasive testing in a defined population. , 1985, Circulation.

[14]  J. Kramer,et al.  Routine coronary angiography prior to elective aortic reconstruction: results of selective myocardial revascularization in patients with peripheral vascular disease. , 1979, Archives of surgery.

[15]  W. Kannel,et al.  Predisposition to atherosclerosis in the head, heart, and legs. The Framingham study. , 1972, JAMA.

[16]  H. Blackburn,et al.  Cardiovascular survey methods. , 1969, Monograph series. World Health Organization.

[17]  V. Devita,et al.  Cancer : Principles and Practice of Oncology , 1982 .

[18]  D. Malenka,et al.  Cholesterol and coronary heart disease. The importance of patient-specific attributable risk. , 1988, Archives of internal medicine.

[19]  I. Ringqvist,et al.  Mortality and Morbidity in Patients with Intermittent Claudication in Relation to the Location of the Occlusive Atherosclerosis in the Leg , 1985, Angiology.

[20]  G. Rose,et al.  Strategy of prevention: lessons from cardiovascular disease. , 1981, British medical journal.

[21]  Takaichiro Suzuki,et al.  :A Ten-year Follow-up Study , 1981 .

[22]  J. Neaton,et al.  Is relationship between serum cholesterol and risk of premature death from coronary heart disease continuous and graded? Findings in 356,222 primary screenees of the Multiple Risk Factor Intervention Trial (MRFIT). , 1986, JAMA.

[23]  N. Breslow,et al.  Statistical methods in cancer research. Volume II--The design and analysis of cohort studies. , 1987, IARC scientific publications.

[24]  A. Reunanen,et al.  Prevalence of intermittent claudication and its effect on mortality. , 2009, Acta medica Scandinavica.

[25]  H. Rockette,et al.  Postoperative adjuvant chemotherapy or BCG for colon cancer: results from NSABP protocol C-01. , 1988, Journal of the National Cancer Institute.

[26]  D. Hill,et al.  The epidemiology of lower limb ischaemia in a new South Wales rural community. , 1981, The Australian and New Zealand journal of surgery.

[27]  N. Breslow,et al.  Statistical methods in cancer research: volume 1- The analysis of case-control studies , 1980 .

[28]  O Munck,et al.  Estimation of peripheral arteriosclerotic disease by ankle blood pressure measurements in a population study of 60-year-old men and women. , 1981, Journal of chronic diseases.

[29]  Dunn Hl,et al.  International Classification of Diseases , 1958, Encyclopedia of Personality and Individual Differences.

[30]  D L Sackett,et al.  An assessment of clinically useful measures of the consequences of treatment. , 1988, The New England journal of medicine.

[31]  A. Folsom,et al.  The Atherosclerosis Risk in Communities (ARIC) Study: design and objectives. The ARIC investigators. , 1989, American journal of epidemiology.

[32]  J. Mann,et al.  Intermittent claudication: factors determining outcome. , 1978, British medical journal.

[33]  H. A. Kahn,et al.  Statistical Methods in Epidemiology , 1989 .

[34]  K. Beach,et al.  Progression of Lower-Extremity Arterial Occlusive Disease in Type II Diabetes Mellitus , 1988, Diabetes Care.

[35]  B. Lewis,et al.  Peripheral vascular disease in a middle-aged population sample. The Jerusalem Lipid Research Clinic Prevalence Study. , 1987, Israel journal of medical sciences.

[36]  L. Janzon,et al.  The Arm‐Ankle Pressure Gradient in Relation to Cardiovascular Risk Factors in Intermittent Claudication , 1981, Circulation.

[37]  K. Beach,et al.  Noninvasive testing vs clinical evaluation of arterial disease. A prospective study. , 1979, JAMA.

[38]  L. Kuller.  Are risk factors for CHD the same at different ages. , 1989, Journal of clinical epidemiology.

[39]  R. Mayer.  Does adjuvant therapy work in colon cancer? , 1990, The New England journal of medicine.

[40]  S. Wolfson,et al.  Carotid and lower extremity arterial disease in elderly adults with isolated systolic hypertension. , 1987, Stroke.

[41]  K. S. Källerö.  Mortality and morbidity in patients with intermittent claudication as defined by venous occlusion plethysmography. A ten-year follow-up study. , 1981, Journal of chronic diseases.