Use of ankle brachial pressure index to predict cardiovascular events and death: a cohort study

Abstract Objective: To determine whether a low ankle brachial pressure index is associated with an increased risk of cardiovascular events and death, and whether the prediction of such events could be improved by including this index. Design: Cohort study. Setting: 11 practices in Edinburgh, Scotland. Subjects: 1592 men and women aged 55–74 years selected at random from the age-sex registers of 11 general practices and followed up for 5 years. Main outcome measures: Incidence of fatal and non-fatal cardiovascular events and all cause mortality. Results: At baseline 90 (5.7%) of subjects had an ankle brachial pressure index </=0.7, 288 (18.2%) had an index </=0.9, and 566 (35.6%) </=1.0. After five years subjects with an index </=0.9 at baseline had an increased risk of non-fatal myocardial infarction (relative risk 1.38, 95% confidence interval 0.88 to 2.16), stroke (1.98, 1.05 to 3.77), cardiovascular death (1.85, 1.15 to 2.97), and all cause mortality (1.58, 1.14 to 2.18) after adjustment for age, sex, coronary disease, and diabetes at baseline. The ability to predict subsequent events was greatly increased by combining the index with other risk factors—for example, hypertensive smokers with normal cholesterol concentrations had a positive predictive value of 25.0%, increasing to 43.8% in subjects with a low index and decreasing to 15.6% in those with a normal index. Conclusion: The ankle brachial pressure index is a good predictor of subsequent cardiovascular events, and improves on predictions by conventional risk factors alone. It is simple and accurate and could be included in routine screening of cardiovascular status. Key messages In this study individuals with a low ankle brachial pressure index had an increased risk of fatal and non-fatal cardiovascular events The index was a good predictor of subsequent cardiovascular events, and improved that of conventional risk factors alone The ankle brachial pressure index could be included in routine screening of cardiovascular status Individuals with a low ankle brachial pressure index require additional monitoring, and might benefit from aspirin or other secondary preventive measures

[1]  J. Gardin,et al.  Subclinical disease as an independent risk factor for cardiovascular disease. , 1995, Circulation.

[2]  B. Hedblad,et al.  Ten year cerebrovascular morbidity and mortality in 68 year old men with asymptomatic carotid stenosis , 1995, BMJ.

[3]  M. Kornitzer,et al.  Ankle/Arm Pressure Index in Asymptomatic Middle-Aged Males: An Independent Predictor of Ten-Year Coronary Heart Disease Mortality , 1995, Angiology.

[4]  B. Hedblad,et al.  Non-invasively detected carotid stenosis and ischaemic heart disease in men with leg arteriosclerosis , 1993, The Lancet.

[5]  J. Polak,et al.  Ankle-arm index as a marker of atherosclerosis in the Cardiovascular Health Study. Cardiovascular Heart Study (CHS) Collaborative Research Group. , 1993, Circulation.

[6]  L. Kuller,et al.  Decreased ankle/arm blood pressure index and mortality in elderly women. , 1993, JAMA.

[7]  L. Kuller,et al.  The Relationship between Ankle‐Arm Index and Mortality in Older Men and Women , 1993, Journal of the American Geriatrics Society.

[8]  R. Langer,et al.  Mortality over a period of 10 years in patients with peripheral arterial disease. , 1992, The New England journal of medicine.

[9]  H Tunstall-Pedoe,et al.  The Dundee coronary risk-disk for management of change in risk factors. , 1991, BMJ.

[10]  R. Prescott,et al.  Edinburgh Artery Study: prevalence of asymptomatic and symptomatic peripheral arterial disease in the general population. , 1991, International journal of epidemiology.

[11]  P. Sleight.  Cardiovascular risk factors and the effects of intervention. , 1991, American heart journal.

[12]  D. Gordon,et al.  High-density lipoprotein--the clinical implications of recent studies. , 1989, The New England journal of medicine.

[13]  M. Bousser,et al.  Fate of the patient with chronic leg ischaemia. A review article. , 1989, The Journal of cardiovascular surgery.

[14]  R. Prescott,et al.  Variability of ankle and brachial systolic pressures in the measurement of atherosclerotic peripheral arterial disease. , 1988, Journal of epidemiology and community health.

[15]  W. Kannel.  New perspectives on cardiovascular risk factors. , 1987, American heart journal.

[16]  R J Prineas,et al.  International diagnostic criteria for acute myocardial infarction and acute stroke. , 1984, American heart journal.

[17]  C E Metz,et al.  Critical evaluation of stress testing in the diagnosis of peripheral vascular disease. , 1982, Surgery.

[18]  Ronald J. Prineas,et al.  The Minnesota code manual of electrocardiographic findings : standards and procedures for measurement and classification , 1982 .

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

[20]  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.

[21]  J. Hobbs,et al.  Ankle systolic pressure measurements in arterial disease affecting the lower extremities , 1969, The British journal of surgery.

[22]  G. A. Rose.  The diagnosis of ischaemic heart pain and intermittent claudication in field surveys. , 1962, Bulletin of the World Health Organization.