Ankle-brachial index and the incidence of cardiovascular events in the Mediterranean low cardiovascular risk population ARTPER cohort

Abstract

BackgroundPeripheral arterial disease (PAD) of the lower limbs is a cardiovascular disease highly prevalent particularly in the asymptomatic form. Its prevalence starts to be a concern in low coronary risk countries like Spain. Few studies have analyzed the relationship between ankle-brachial index (ABI) and cardiovascular morbi-mortality in low cardiovascular risk countries like Spain where we observe significant low incidence of ischemic heart diseases together with high prevalence of cardiovascular risk factors. The objective of this study is to determine the relationship between pathological ABI and incidence of cardiovascular events (coronary disease, cerebrovascular disease, symptomatic aneurism of abdominal aorta, vascular surgery) and death in the >49 year population-based cohort in Spain (ARTPER).MethodsBaseline ABI was measured in 3,786 randomly selected patients from 28 Primary Health Centers in Barcelona, distributed as: ABI<0.9 peripheral arterial disease (PAD), ABI ≥1.4 arterial calcification (AC), ABI 0.9-1.4 healthy; and followed during 4 years.Results3,307 subjects were included after excluding those with previous vascular events. Subjects with abnormal ABI were older with higher proportion of men, smokers and diabetics. 260 people presented cardiovascular events (incidence 2,117/100,000 person-years) and 124 died from any cause (incidence 978/100,000 person-years). PAD had two-fold greater risk of coronary disease (adjusted hazard ratio (HR) = 2.0, 95% confidence interval (CI) 1.3-3.2) and increased risk of vascular surgery (HR = 5.6, 95%CI 2.8-11.5) and mortality (HR = 1.8, 95%CI 1.4-2.5). AC increased twice risk of cerebrovascular events (HR = 1.9, 95%CI 1.0-3.5) with no relationship with ischemic heart disease.ConclusionsPAD increases coronary disease risk and AC cerebrovascular disease risk in low cardiovascular risk Mediterranean population. ABI could be a useful tool to detect patients at risk in Primary Health Care.

Adding low ankle brachial index to classical risk factors improves the prediction of major cardiovascular events. The REGICOR study

“…We found a strong association between pathological ABI and CHD and CVD events incidence (HR ¼ 2.46 and 2.64, respectively), similar to that reported in the ABI Collaboration Meta-analysis (HR ¼ 2.97 in men and 3.05 in women, for major coronary events) [16], which included 16 population cohort studies and more than 48,000 individuals. This association also has been reported in Mediterranean populations [15,35], with a magnitude of association similar to that observed in our study.…”

Association between novel arterial stiffness indices and risk factors of cardiovascular disease

“…Several studies have shown that pulse wave velocity (PWV), a noninvasive clinical index of arterial stiffness, predicts cardiovascular events and all-cause mortality [3–8]. Prevention and early detection of arterial stiffness need to be promoted to avoid severe cardiovascular events.…”

The Cardio-Ankle Vascular Index and Ankle-Brachial Index in Young Russians

“…The ABI is helpful for determining the arterial conditions linked to the lower limbs (i.e., the existence of peripheral arterial disease) 25) , and is a predictor of CVD events 26) . Even when the ABI level is 0.9 (as in our study subjects), the ABI measurement is useful for predicting the development of CVD 26) .…”