doi: 10.1161/CIRCULATIONAHA.105.570903
(Circulation. 2006;113:388-393.)
© 2006 American Heart Association, Inc.
Epidemiology |
Mortality and Cardiovascular Risk Across the Ankle-Arm Index Spectrum
Results From the Cardiovascular Health Study
From the Nephrology Division (A.M.O.), Department of Medicine, VA Medical Center San Francisco and University of California, San Francisco, Calif; Collaborative Health Studies Coordinating Center (R.K.), Seattle, Wash; General Internal Medicine Section (M.G.S.), Veterans Affairs Medical Center, San Francisco, Calif, and Departments of Medicine, Epidemiology and Biostatistics, University of California, San Francisco, Calif; Departments of Medicine and Pathology (M.C.), University of Vermont, Burlington, Vt; and Department of Epidemiology (A.B.N.), University of Pittsburgh Graduate School of Public Health and the Division of Geriatric Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pa.
Correspondence to Ann M. O’Hare, MD, MA, Box 111J (Nephrology), VA Medical Center, San Francisco, 4150 Clement St, San Francisco, CA 94121. E-mail Ann.O’Hare{at}med.va.gov
Received June 22, 2005; revision received November 16, 2005; accepted November 18, 2005.
Background— A low ankle-arm index (AAI) is a strong predictor of mortality and cardiovascular events. A high AAI also appears to be associated with higher mortality risk in select populations. However, mortality and cardiovascular risk across the AAI spectrum have not been described in a more broadly defined population.
Methods and Results— We examined total and cardiovascular mortality and cardiovascular events across the AAI spectrum among 5748 participants in the Cardiovascular Health Study (CHS). The mean age of the sample population was 73±6 years, and the sample included 3289 women (57%) and 883 blacks (15%). The median duration of follow-up was 11.1 (0.1 to 12) years for mortality and 9.6 (0.1 to 12.1) years for cardiovascular events. There were 2311 deaths (953 of which were cardiovascular) and 1491 cardiovascular events during follow-up. After adjustment for potential confounders, AAI measurements 
0.60 (hazard ratio [HR] 1.82, 95% CI 1.42 to 2.32), 0.61 to 0.7 (HR 2.08, 95% CI 1.61 to 2.69), 0.71 to 0.8 (HR 1.80, 95% CI 1.44 to 2.26), 0.81 to 0.9 (HR 1.73 95% CI 1.43 to 2.11), 0.91 to 1.0 (HR 1.40, 95% CI 1.20 to 1.63), and >1.40 (HR 1.57, 95% CI 1.07 to 2.31) were associated with higher mortality risk from all causes compared with the referent group (AAI 1.11 to 1.20). The pattern was similar for cardiovascular mortality. For cardiovascular events, risk was higher at all AAI levels <1 but not for AAI levels >1.4 (HR 1.00, 95% CI 0.57 to 1.74). The association of a high AAI with mortality was stronger in men than in women and in younger than in older cohort members.
Conclusions— In a cohort of community-dwelling elders, mortality risk was higher than the referent category of 1.11 to 1.2 among participants with AAI values above the traditional cutpoint of 0.9 (ie, 0.91 to 1.0 and >1.4), and the specific association of AAI with mortality varied by age and gender.
Key Words: epidemiology • peripheral vascular disease • mortality
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