Heart Failure Risk Across the Spectrum of Ankle-Brachial Index

Gupta, Deepak K.; Skali, Hicham; Claggett, Brian; Kasabov, Rumen; Cheng, Susan; Shah, Amil M.; Loehr, Laura R.; Heiss, Gerardo; Nambi, Vijay; Aguilar, David; Wruck, Lisa; Matsushita, Kunihiro; Folsom, Aaron R.; Rosamond, Wayne D.; Solomon, Scott D.

doi:10.1016/j.jchf.2014.05.008

Cited by 49 publications

(29 citation statements)

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“…In a community cohort of middle aged Americans, it was found that a low ABI was associated with a 40% higher risk of heart failure than a normal ABI, and a borderline ABI was also associated with an increased risk of heart failure [20]. Similarly, in the present study, we found that low and borderline ABIs were strongly associated with future heart failure in hospitalized cardiology patients.…”

Section: Discussionsupporting

confidence: 83%

Impressive predictive value of ankle-brachial index for very long-term outcomes in patients with cardiovascular disease: IMPACT-ABI study

et al. 2017

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BackgroundThe ankle—brachial index (ABI) is a marker of generalized atherosclerosis and is predictive of future cardiovascular events. However, few studies have assessed its relation to long-term future cardiovascular events, especially in patients with borderline ABI. We therefore evaluated the relationship between long-term future cardiovascular events and ABI.MethodsIn the IMPACT-ABI study, a single-center, retrospective cohort study, we enrolled 3131 consecutive patients (67 ± 13 years; 82% male) hospitalized for cardiovascular disease and measured ABI between January 2005 and December 2012. After excluding patients with an ABI > 1.4, the remaining 3056 patients were categorized as having low ABI (≤ 0.9), borderline ABI (0.91–0.99), or normal ABI (1.00–1.40). The primary endpoint was MACE (cardiovascular death, myocardial infarction [MI] and stroke). The secondary endpoints were cardiovascular death, MI, stroke, admission due to heart failure, and major bleeding.ResultsDuring a 4.8-year mean follow-up period, the incidences of MACE (low vs. borderline vs. normal: 32.9% vs. 25.0% vs. 14.6%, P<0.0001) and cardiovascular death (26.2% vs. 18.7% vs. 8.9%, P<0.0001) differed significantly across ABIs. The incidences of stroke (9.1% vs. 8.6% vs. 4.8%, P<0.0001) and heart failure (25.7% vs. 20.8% vs. 8.9%, P<0.0001) were significantly higher in the low and borderline ABI groups than in the normal ABI group. But the incidences of MI and major bleeding were similar in the borderline and normal ABI groups. The hazard ratios for MACE adjusted for traditional atherosclerosis risk factors were significantly higher in patients with low and borderline ABI than those with normal ABI (HR, 1.93; 95%CI: 1.44–2.59, P < 0.0001, HR, 1.54; 95% CI: 1.03–2.29, P = 0.035).ConclusionsThe incidence of long-term adverse events was markedly higher among patients with low or borderline ABI than among those with normal ABI. This suggests that more attention should be paid to patients with borderline ABIs, especially with regard to cardiovascular death, stroke, and heart failure.

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Section: Discussionsupporting

confidence: 83%

Impressive predictive value of ankle-brachial index for very long-term outcomes in patients with cardiovascular disease: IMPACT-ABI study

et al. 2017

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“…Our study demonstrates future diabetes as another adverse clinical consequence of PAD in addition to its known complications such as other cardiovascular diseases and impaired functional status [3, 4, 7, 26, 40–44]. This finding is important given the adverse outcomes associated with diabetes [44–49].…”

Section: Discussionmentioning

confidence: 56%

Ankle-brachial index and incident diabetes mellitus: the atherosclerosis risk in communities (ARIC) study

Hua

Loehr

Tanaka

et al. 2016

Cardiovasc Diabetol

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BackgroundIndividuals with peripheral artery disease (PAD) often have reduced physical activity, which may increase the future risk of diabetes mellitus. Although diabetes is a risk factor for PAD, whether low ankle-brachial index (ABI) predates diabetes has not been studied.MethodsWe examined the association of ABI with incident diabetes using Cox proportional hazards models in the ARIC Study. ABI was measured in 12,247 black and white participants without prevalent diabetes at baseline (1987–1989). Incident diabetes cases were identified by blood glucose levels at three subsequent visits (1990–92, 1993–95, and 1996–98) or self-reported physician diagnosis or medication use at those visits or during annual phone interview afterward through 2011.ResultsA total of 3305 participants developed diabetes during a median of 21 years of follow-up. Participants with low (≤0.90) and borderline low (0.91–1.00) ABI had 30–40% higher risk of future diabetes as compared to those with ABI of 1.10–1.20 in the demographically adjusted model. The associations were attenuated after further adjustment for other potential confounders but remained significant for ABI 0.91–1.00 (HR = 1.17, 95% CI 1.04–1.31) and marginally significant for ABI ≤ 0.90 (HR = 1.19, 0.99–1.43). Although the association was largely consistent across subgroups, a stronger association was seen in participants without hypertension, those with normal fasting glucose, and those with a history of stroke compared to their counterparts.ConclusionsLow ABI was modestly but independently associated with increased risk of incident diabetes in the general population. Clinical attention should be paid to the glucose trajectory among people with low ABI but without diabetes.Electronic supplementary materialThe online version of this article (doi:10.1186/s12933-016-0476-4) contains supplementary material, which is available to authorized users.

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“…However, the independent associations of lower ABI with lower grip strength suggest the involvement of systemic pathophysiology. Low ABI is an indicator of systemic atherosclerosis and thus, those with low ABI often have other manifestations of cardiovascular disease such as stroke and heart failure, 36 which may lead to poor systemic physical function. However, of note, the association of ABI with physical function was independent of other cardiovascular subtypes.…”

Section: Discussionmentioning

confidence: 99%

Ankle-brachial index and physical function in older individuals: The Atherosclerosis Risk in Communities (ARIC) study

et al. 2017

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Background and aims Most prior studies investigating the association of lower extremity peripheral artery disease (PAD) with physical function were small or analyzed selected populations (e.g., patients at vascular clinics or persons with reduced function), leaving particular uncertainty regarding the association in the general community. Methods Among 5,262 ARIC participants (age 71-90 years during 2011-2013), we assessed the cross-sectional association of ankle-brachial index (ABI) with the Short Physical Performance Battery (SPPB) score (0-12), its individual components (chair stands, standing balance, and gait speed) (0-4 points each), and grip strength after accounting for potential confounders, including a history of coronary disease, stroke, or heart failure. Results There were 411 participants (7.8%) with low ABI ≤0.90 and 469 (8.9%) participants with borderline low ABI 0.91-1.00. Both ABI ≤0.90 and 0.91-1.00 were independently associated with poor physical function (SPPB score ≤6) compared to ABI 1.11-1.20 (adjusted odds ratio 2.10 [95% CI 1.55-2.84] and 1.86 [1.38-2.51], respectively). The patterns were largely consistent across subgroups by clinical conditions (e.g., leg pain or other cardiovascular diseases), in every SPPB component, and for grip strength. ABI >1.3 (472 participants [9.0%]), indicative of non-compressible pedal arteries, was related to lower physical function as well but did not necessarily reach significance. Conclusions In community-dwelling older adults, low and borderline low ABI suggestive of PAD were independently associated with poorer systemic physical function compared to those with normal ABI. Clinical attention to PAD as a potential contributor to poor physical function is warranted in community-dwelling older adults.

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Heart Failure Risk Across the Spectrum of Ankle-Brachial Index

Cited by 49 publications

References 50 publications

Impressive predictive value of ankle-brachial index for very long-term outcomes in patients with cardiovascular disease: IMPACT-ABI study

Impressive predictive value of ankle-brachial index for very long-term outcomes in patients with cardiovascular disease: IMPACT-ABI study

Ankle-brachial index and incident diabetes mellitus: the atherosclerosis risk in communities (ARIC) study

Ankle-brachial index and physical function in older individuals: The Atherosclerosis Risk in Communities (ARIC) study

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