The Ankle-Brachial Index in the Elderly and Risk of Stroke, Coronary Disease, and Death

Murabito, Joanne M.; Evans, Jane C.; Larson, Martin G.; Nieto, Kenneth; Levy, Daniel; Wilson, Peter W.F.

doi:10.1001/archinte.163.16.1939

Cited by 283 publications

(212 citation statements)

References 34 publications

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“…To determine the ankle brachial index, BP was measured twice on both the arms and at both the ankles using an 8‐MHz Doppler pen probe and an ultrasonic Doppler flow detector (Park Medical Electronics Inc), as described elsewhere 14. Participants also underwent transthoracic echocardiography, and M‐mode images were used to determine measurements of LV structure.…”

Section: Methodsmentioning

confidence: 99%

Residual Cardiovascular Risk in Individuals on Blood Pressure–Lowering Treatment

Lieb

Enserro

Sullivan

et al. 2015

JAHA

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BackgroundHypertensive individuals on blood pressure (BP)–lowering treatment with BP in the normal or high‐normal range have higher cardiovascular risk than untreated persons with usual BP in the same range. This residual risk (relative and absolute) is not well quantified and may be attributable in part to the higher burden of subclinical disease in treated individuals.Methods and ResultsWe assigned 3024 Framingham Offspring Cohort participants to 5 categories based on systolic BP (SBP) and diastolic BP (DBP) and use of BP‐lowering treatment: (1) untreated SBP/DBP <120/80 mm Hg; (2) untreated SBP/DB ≥120/80 to <140/90 mm Hg; (3) treated SBP/DBP <140/90 mm Hg; (4) untreated SBP/DBP ≥140/90 mm Hg; and (5) treated SBP/DBP ≥140/90 mm Hg. A composite subclinical disease score was constructed, including information on left ventricular hypertrophy, systolic dysfunction, carotid ultrasound abnormality, peripheral artery disease, and microalbuminuria. The prevalence of subclinical disease rose across BP groups, as did the event rates for incident cardiovascular disease (449 events, median follow‐up of 11 years; group 1, 0.65 event per 100 person‐years; group 5, 3.20 events per 100 person‐years; P<0.0001 for trend). On multivariable adjustment, treated hypertensives in groups 3 and 5 had 50% (95% CI 13% to 99%) and 28% (95% CI −6% to 73%) higher hazards, respectively, of developing cardiovascular disease compared with their untreated counterparts with similar levels of BP (groups 1 and 2 and group 4, respectively). The increased risk of cardiovascular disease in treated hypertensives was attributable in part to greater subclinical disease burden.ConclusionsTreated hypertensives have higher subclinical cardiovascular disease burden, which partly explains their higher cardiovascular disease risk compared with untreated persons with similar BP levels.

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Section: Methodsmentioning

confidence: 99%

Residual Cardiovascular Risk in Individuals on Blood Pressure–Lowering Treatment

Lieb

Enserro

Sullivan

et al. 2015

JAHA

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“…Peripheral arterial disease (PAD) not only decreases quality of life due to intermittent claudication, but also, more importantly, is a powerful predictor of future cardiovascular and cerebrovascular events such as myocardial infarction, stroke, and death (Smith et al 1990, Criqui et al 1992, Murabito et al 2003. Previous clinical studies have shown that PAD is two-to three-fold more prevalent in men than in women (Dormandy & Rutherford 2000) and that low testosterone levels are associated with lower extremity PAD in elderly men (Tivesten et al 2007).…”

Section: Androgens and Peripheral Arterial Diseasementioning

confidence: 99%

Effects of androgens on cardiovascular remodeling

Ikeda

Aihara

Yoshida³

et al. 2012

Journal of Endocrinology

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Androgens, the male sex hormones, exert various biological effects on many target organs through the transcriptional effects of the nuclear androgen receptor (AR). ARs are expressed not only in classical target organs, such as the brain, genital organs, bone, and skeletal muscles, but also in the cardiovascular system. Because the female sex hormones estrogens are wellknown to protect against cardiovascular disease, sex has been considered to have a significant clinical impact on cardiovascular mortality. However, the influence of androgens on the cardiovascular system has not been fully elucidated. To clarify this issue, we analyzed the effects of administration of angiotensin II and doxorubicin, an anticancer agent, in a loading model in male wild-type and AR-deficient mice. In this review, we focus on the actions of androgens as potential targets for the prevention of cardiovascular diseases in males.

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“…Persons with PAD have 3‐ to 5‐fold higher mortality risk compared with those without PAD. Increased mortality is mainly driven by a higher cardiovascular disease (CVD) risk5, 6 and reflects the underlying systemic atherosclerosis process in PAD patients 7…”

Section: Introductionmentioning

confidence: 99%

Lower Extremity Peripheral Artery Disease and Quality of Life Among Older Individuals in the Community

Coresh

Selvin

et al. 2017

JAHA

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BackgroundEvidence regarding the association of lower extremity peripheral arterial disease with quality of life (QOL) is mainly from selected clinical populations or relatively small clinical cohorts. Thus, we investigated this association in community‐derived populations.Methods and ResultsUsing data of 5115 participants aged 66 to 90 years from visit 5 (2011‐2013) of the Atherosclerosis Risk in Communities Study, we quantified the associations of ankle‐brachial index (ABI) with several QOL parameters, including 12‐item Short‐Form Health Survey (SF‐12), after accounting for potential confounders using linear and logistic regression models. Peripheral arterial disease defined by an ABI <0.90 (n=402), was independently associated with a low SF‐12 Physical Component Summary score (−3.26 [95% CI −5.60 to −0.92]), compared to the ABI reference 1.10 to 1.19 (n=1900) but not with the Mental Component Summary score (−0.07 [−2.21 to 2.06]). A low ABI was significantly associated with poorer status of all SF‐12 physical domains (physical functioning, role‐physical, bodily pain, and general health) but only vitality out of 4 mental domains. Similarly, low ABI values were more consistently associated with other physically related QOL parameters (leisure‐time exercise/activity/walking) than mentally related parameters (significant depressive symptoms and hopeless feeling). Lower physical QOL was observed even in individuals with borderline low ABI (0.90 to 0.99; n=426).ConclusionsLow ABI (even borderline) was independently associated with poor QOL, especially for physical components, in community‐dwelling older adults. QOL is a critical element for older adults, and thus, further studies are warranted to assess whether peripheral arterial disease‐specific management can improve QOL in older populations.

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The Ankle-Brachial Index in the Elderly and Risk of Stroke, Coronary Disease, and Death

Abstract: A low ABI is associated with risk of stroke or transient ischemic attack in the elderly. These results need to be confirmed in larger studies.

Cited by 283 publications

References 34 publications

Residual Cardiovascular Risk in Individuals on Blood Pressure–Lowering Treatment

Residual Cardiovascular Risk in Individuals on Blood Pressure–Lowering Treatment

Effects of androgens on cardiovascular remodeling

Lower Extremity Peripheral Artery Disease and Quality of Life Among Older Individuals in the Community

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