Ankle-brachial index and subsequent risk of incident and recurrent cardiovascular events in older adults: The Atherosclerosis Risk in Communities (ARIC) study.

Frances M Wang, Chao Yang, Shoshana H Ballew, Corey A Kalbaugh, Michelle L Meyer, Hirofumi Tanaka, Gerardo Heiss, Matthew Allison, Maya Salameh, Josef Coresh, Kunihiro Matsushita
Author Information
  1. Frances M Wang: Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
  2. Chao Yang: Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
  3. Shoshana H Ballew: Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
  4. Corey A Kalbaugh: Clemson University, Clemson, SC, USA.
  5. Michelle L Meyer: University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
  6. Hirofumi Tanaka: University of Texas at Austin, Austin, TX, USA.
  7. Gerardo Heiss: University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
  8. Matthew Allison: University of California San Diego, San Diego, CA, USA.
  9. Maya Salameh: Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
  10. Josef Coresh: Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
  11. Kunihiro Matsushita: Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA. Electronic address: kuni.matsushita@jhu.edu.

Abstract

BACKGROUND AND AIMS: The ankle-brachial index (ABI) is a diagnostic test for screening and detecting peripheral artery disease (PAD), as well as a risk enhancer in the AHA/ACC guidelines on the primary prevention of atherosclerotic cardiovascular disease (ASCVD). However, our understanding of the association between ABI and cardiovascular risk in contemporary older populations is limited. Additionally, the prognostic value of ABI among individuals with prior ASCVD is not well understood.
METHODS: Among 5,003 older adults at ARIC visit 5 (2011-2013) (4,160 without prior ASCVD [median age 74 years, 38% male], and 843 with ASCVD [median age 76 years, 65% male]), we quantified the association between ABI and the risk of heart failure (HF), and composite coronary heart disease and stroke (CHD/stroke) using multivariable Cox regression models.
RESULTS: Over a median follow-up of 5.5 years, we observed 400 CHD/stroke events and 338 HF cases (242 and 199 cases in those without prior ASCVD, respectively). In participants without a history of ASCVD, a low ABI ≤0.9 (relative to ABI 1.11-1.20) was associated with both CHD/stroke and HF (adjusted hazard ratios 2.40 [95% CI: 1.55-3.71] and 2.23 [1.40-3.56], respectively). In those with prior ASCVD, low ABI was not significantly associated with CHD/stroke, but was with HF (7.12 [2.47-20.50]). The ABI categories of 0.9-1.2 and > 1.3 were also independently associated with increased HF risk. Beyond traditional risk factors, ABI significantly improved the risk discrimination of CHD/stroke in those without ASCVD and HF, regardless of baseline ASCVD.
CONCLUSIONS: Low ABI was associated with CHD/stroke in those without prior ASCVD and higher risk of HF regardless of baseline ASCVD status. These results support ABI as a risk enhancer for guiding primary cardiovascular prevention and suggest its potential value in HF risk assessment for older adults.

Keywords

References

  1. Stroke. 1999 Apr;30(4):736-43 [PMID: 10187871]
  2. Circulation. 2006 Jan 24;113(3):388-93 [PMID: 16432070]
  3. J Am Coll Cardiol. 2019 Jun 25;73(24):e285-e350 [PMID: 30423393]
  4. Circ Heart Fail. 2012 Mar 1;5(2):152-9 [PMID: 22271752]
  5. Thromb Haemost. 1989 Feb 28;61(1):15-9 [PMID: 2526384]
  6. Circulation. 2004 Feb 17;109(6):733-9 [PMID: 14970108]
  7. J Am Coll Cardiol. 2014 Jul 1;63(25 Pt B):2935-2959 [PMID: 24239921]
  8. J Clin Epidemiol. 2001 Oct;54(10):973-8 [PMID: 11576807]
  9. Curr Opin Cardiol. 2016 Nov;31(6):662-669 [PMID: 27652814]
  10. J Clin Epidemiol. 1996 Feb;49(2):223-33 [PMID: 8606324]
  11. Circulation. 2019 Sep 10;140(11):e596-e646 [PMID: 30879355]
  12. Mayo Clin Proc. 2010 Jul;85(7):678-92 [PMID: 20592174]
  13. Am J Epidemiol. 2005 Jul 1;162(1):33-41 [PMID: 15961584]
  14. J Am Heart Assoc. 2018 Jan 22;7(2): [PMID: 29358195]
  15. Circulation. 2002 Dec 17;106(25):3143-421 [PMID: 12485966]
  16. Am J Hypertens. 2012 May;25(5):535-41 [PMID: 22357412]
  17. Am J Epidemiol. 1989 Apr;129(4):687-702 [PMID: 2646917]
  18. JAMA. 2008 Jul 9;300(2):197-208 [PMID: 18612117]
  19. Atherosclerosis. 2020 Feb;294:62-71 [PMID: 31812251]
  20. Circulation. 2019 Aug 6;140(6):449-458 [PMID: 31280589]
  21. Atherosclerosis. 1993 Jul;101(2):191-202 [PMID: 8379964]
  22. J Vasc Surg. 2008 Nov;48(5):1197-203 [PMID: 18692981]
  23. JAMA. 2018 Jul 10;320(2):177-183 [PMID: 29998344]
  24. J Am Coll Cardiol. 2017 Mar 21;69(11):e71-e126 [PMID: 27851992]
  25. JAMA Intern Med. 2016 Apr;176(4):473-82 [PMID: 26998708]
  26. Arterioscler Thromb Vasc Biol. 1999 Mar;19(3):538-45 [PMID: 10073955]
  27. Circulation. 2012 Dec 11;126(24):2890-909 [PMID: 23159553]
  28. J Am Coll Cardiol. 2010 Oct 26;56(18):1506-12 [PMID: 20951328]
  29. Circulation. 2020 Mar 3;141(9):e139-e596 [PMID: 31992061]
  30. Arch Intern Med. 2003 Sep 8;163(16):1939-42 [PMID: 12963567]
  31. JACC Heart Fail. 2014 Oct;2(5):447-54 [PMID: 25194293]
  32. Am J Cardiol. 2010 Jan 1;105(1):129-32 [PMID: 20102904]
  33. Eur Heart J. 2018 Jul 1;39(25):2412-2419 [PMID: 29579246]

Grants

  1. T32 HL007024/NHLBI NIH HHS
  2. HHSN268201700002C/NHLBI NIH HHS
  3. HHSN268201700001I/NHLBI NIH HHS
  4. HHSN268201700004I/NHLBI NIH HHS
  5. HHSN268201700004C/NHLBI NIH HHS
  6. HHSN268201700003I/NHLBI NIH HHS
  7. HHSN268201700005C/NHLBI NIH HHS
  8. HHSN268201700001C/NHLBI NIH HHS
  9. HHSN268201700003C/NHLBI NIH HHS
  10. HHSN268201700002I/NHLBI NIH HHS
  11. HHSN268201700005I/NHLBI NIH HHS

MeSH Term

Aged
Ankle Brachial Index
Atherosclerosis
Coronary Disease
Female
Humans
Incidence
Male
Peripheral Arterial Disease
Risk Assessment
Risk Factors

Word Cloud

Created with Highcharts 10.0.0ABIASCVDriskHFCHD/strokecardiovascularpriorwithoutdiseaseolder5associatedindexadultsyears2wellenhancerprimarypreventionassociationvalueARIC[medianagemale]hearteventscasesrespectivelylow1significantlyregardlessbaselineassessmentAnkle-brachialRiskBACKGROUNDANDAIMS:ankle-brachialdiagnostictestscreeningdetectingperipheralarteryPADAHA/ACCguidelinesatheroscleroticHoweverunderstandingcontemporarypopulationslimitedAdditionallyprognosticamongindividualsunderstoodMETHODS:Among003visit2011-201341607438%8437665%quantifiedfailurecompositecoronarystrokeusingmultivariableCoxregressionmodelsRESULTS:medianfollow-upobserved400338242199participantshistory≤09relative11-120adjustedhazardratios40[95%CI:55-371]23[140-356]712[247-2050]categories09-1and > 13alsoindependentlyincreasedBeyondtraditionalfactorsimproveddiscriminationCONCLUSIONS:Lowhigherstatusresultssupportguidingsuggestpotentialsubsequentincidentrecurrentadults:AtherosclerosisCommunitiesstudyAtheroscleroticOlder

Similar Articles

Cited By