Circulation, Vol 88, 837-845, Copyright © 1993 by American Heart Association
AB Newman, DS Siscovick, TA Manolio, J Polak, LP Fried, NO Borhani and SK Wolfson
BACKGROUND. Peripheral arterial disease measured noninvasively by the
ankle-arm index (AAI) is common in older adults, largely asymptomatic, and
associated with clinically manifest cardiovascular disease (CVD). The
criteria for an abnormal AAI have varied in previous studies. To determine
whether there is an inverse dose-response relation between the AAI and
clinical CVD, subclinical disease, and risk factors, we examined the
relation of the AAI to cardiovascular risk factors, other noninvasive
measures of subclinical atherosclerosis using carotid ultrasound,
echocardiography and electrocardiography, and clinical CVD. METHODS AND
RESULTS. The AAI was measured in 5084 participants > or = 65 years old
at the baseline examination of the Cardiovascular Health Study. All
subjects had detailed assessment of prevalent CVD, measures of
cardiovascular risk factors, and noninvasive measures of disease.
Participants were stratified by baseline clinical CVD status and AAI (<
0.8, > or = 0.8 to < 0.9, > or = 0.9 to < 1.0, > or = 1.0 to
< 1.5). Analyses tested for a dose-response relation of the AAI with
clinical CVD, risk factors, and subclinical disease. The cumulative
frequency of a low AAI was 7.4% of participants < 0.8, 12.4% < 0.9,
and 23.6% < 1.0. participants with an AAI < 0.8 were more than twice
as likely as those with an AAI of 1.0 to 1.5 to have a history of
myocardial infarction, angina, congestive heart failure, stroke, or
transient ischemic attack (all P < .01). In participants free of
clinical CVD at baseline, the AAI was inversely related to history of
hypertension, history of diabetes, and smoking, as well as systolic blood
pressure, serum creatinine, fasting glucose, fasting insulin, measures of
pulmonary function, and fibrinogen level (all P < .01). Risk factor
associations with the AAI were similar in men and women free of CVD except
for serum total and low-density lipoprotein cholesterol, which were
inversely associated with AAI level only in women. Risk factors associated
with an AAI of < 1.0 in multivariate analysis included smoking (odds
ratio [OR], 2.55), history of diabetes (OR, 3.84), increasing age (OR,
1.54), and nonwhite race (OR, 2.36). In the 3372 participants free of
clinical CVD, other noninvasive measures of subclinical CVD, including
carotid stenosis by duplex scanning, segmental wall motion abnormalities by
echocardiogram, and major ECG abnormalities were inversely related to the
AAI (all P < .01). CONCLUSIONS. There was an inverse dose-response
relation of the AAI with CVD risk factors and subclinical and clinical CVD
among older adults. The lower the AAI, the greater the increase in CVD
risk; however, even those with modest, asymptomatic reductions in the AAI
(0.8 to 1.0) appear to be at increased risk of CVD.
ARTICLES
Ankle-arm index as a marker of atherosclerosis in the Cardiovascular Health Study. Cardiovascular Heart Study (CHS) Collaborative Research Group
Department of Medicine, Medical College of Pennsylvania, Pittsburgh.
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Y. Fujiwara, P. H. M. Chaves, R. Takahashi, H. Amano, H. Yoshida, S. Kumagai, K. Fujita, D. G. Wang, and S. Shinkai Arterial Pulse Wave Velocity as a Marker of Poor Cognitive Function in an Elderly Community-Dwelling Population J. Gerontol. A Biol. Sci. Med. Sci., May 1, 2005; 60(5): 607 - 612. [Abstract] [Full Text] [PDF]
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J. Ness, W. S. Aronow, E. Newkirk, and D. McDanel Prevalence of Symptomatic Peripheral Arterial Disease, Modifiable Risk Factors, and Appropriate Use of Drugs in the Treatment of Peripheral Arterial Disease in Older Persons Seen in a University General Medicine Clinic J. Gerontol. A Biol. Sci. Med. Sci., February 1, 2005; 60(2): 255 - 257. [Abstract] [Full Text] [PDF]
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M. S. Edwards, T. E. Craven, G. L. Burke, R. H. Dean, and K. J. Hansen Renovascular Disease and the Risk of Adverse Coronary Events in the Elderly: A Prospective, Population-Based Study Arch Intern Med, January 24, 2005; 165(2): 207 - 213. [Abstract] [Full Text] [PDF]
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 T. C. Collins, N. J. Petersen, M. Suarez-Almazor, and C. M. Ashton Ethnicity and Peripheral Arterial Disease Mayo Clin. Proc., January 1, 2005; 80(1): 48 - 54. [Abstract] [PDF]
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C. L. Leibson, J. E. Ransom, W. Olson, B. R. Zimmerman, W. M. O'Fallon, and P. J. Palumbo Peripheral Arterial Disease, Diabetes, and Mortality Diabetes Care, December 1, 2004; 27(12): 2843 - 2849. [Abstract] [Full Text] [PDF]
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G. P. Clagett, M. Sobel, M. R. Jackson, G. Y. H. Lip, M. Tangelder, and R. Verhaeghe Antithrombotic Therapy in Peripheral Arterial Occlusive Disease: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy Chest, September 1, 2004; 126(3_suppl): 609S - 626S. [Abstract] [Full Text] [PDF]
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E. Selvin and T. P. Erlinger Prevalence of and Risk Factors for Peripheral Arterial Disease in the United States: Results From the National Health and Nutrition Examination Survey, 1999-2000 Circulation, August 10, 2004; 110(6): 738 - 743. [Abstract] [Full Text] [PDF]
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M. M. McDermott, K. Liu, P. Greenland, J. M. Guralnik, M. H. Criqui, C. Chan, W. H. Pearce, J. R. Schneider, L. Ferrucci, L. Celic, et al. Functional Decline in Peripheral Arterial Disease: Associations With the Ankle Brachial Index and Leg Symptoms JAMA, July 28, 2004; 292(4): 453 - 461. [Abstract] [Full Text] [PDF]
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A. R. Brady, S. G. Thompson, F. G. R. Fowkes, R. M. Greenhalgh, J. T. Powell, and on behalf of the UK Small Aneurysm Trial Participa Abdominal Aortic Aneurysm Expansion: Risk Factors and Time Intervals for Surveillance Circulation, July 6, 2004; 110(1): 16 - 21. [Abstract] [Full Text] [PDF]
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E. W. Gregg, P. Sorlie, R. Paulose-Ram, Q. Gu, M. S. Eberhardt, M. Wolz, V. Burt, L. Curtin, M. Engelgau, and L. Geiss Prevalence of Lower-Extremity Disease in the U.S. Adult Population >=40 Years of Age With and Without Diabetes: 1999-2000 National Health and Nutrition Examination Survey Diabetes Care, July 1, 2004; 27(7): 1591 - 1597. [Abstract] [Full Text] [PDF]
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A. Navas-Acien, E. Selvin, A. R. Sharrett, E. Calderon-Aranda, E. Silbergeld, and E. Guallar Lead, Cadmium, Smoking, and Increased Risk of Peripheral Arterial Disease Circulation, June 29, 2004; 109(25): 3196 - 3201. [Abstract] [Full Text] [PDF]
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S. C. Smith Jr, R. V. Milani, D. K. Arnett, J. R. Crouse III, M. M. McDermott, P. M Ridker, R. S. Rosenson, K. A. Taubert, and P. W.F. Wilson Atherosclerotic Vascular Disease Conference: Writing Group II: Risk Factors Circulation, June 1, 2004; 109(21): 2613 - 2616. [Full Text] [PDF]
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D. P. Faxon, V. Fuster, P. Libby, J. A. Beckman, W. R. Hiatt, R. W. Thompson, J. N. Topper, B. H. Annex, J. H. Rundback, R. P. Fabunmi, et al. Atherosclerotic Vascular Disease Conference: Writing Group III: Pathophysiology Circulation, June 1, 2004; 109(21): 2617 - 2625. [Full Text] [PDF]
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A. M. O'Hare, E. Vittinghoff, J. Hsia, and M. G. Shlipak Renal Insufficiency and the Risk of Lower Extremity Peripheral Arterial Disease: Results from the Heart and Estrogen/Progestin Replacement Study (HERS) J. Am. Soc. Nephrol., April 1, 2004; 15(4): 1046 - 1051. [Abstract] [Full Text] [PDF]
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A. Benchimol, V. Bernard, X. Pillois, N. T. Hong, D. Benchimol, and J. Bonnet Validation of a New Method of Detecting Peripheral Artery Disease by Determination of Ankle-Brachial Index Using an Automatic Blood Pressure Device Angiology, March 1, 2004; 55(2): 127 - 134. [Abstract] [PDF]
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 J. K. Raines, J. Farrar, K. Noicely, J. Pena, W. W. Davis, H. J. Willens, and D. D. Wallace Ankle/Brachial Index in the Primary Care Setting Vascular and Endovascular Surgery, March 1, 2004; 38(2): 131 - 136. [Abstract] [PDF]
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J. Hsia, M. H. Criqui, R. J. Rodabough, R. D. Langer, H. E. Resnick, L. S. Phillips, M. Allison, D. E. Bonds, K. Masaki, P. Caralis, et al. Estrogen Plus Progestin and the Risk of Peripheral Arterial Disease: The Women's Health Initiative Circulation, February 10, 2004; 109(5): 620 - 626. [Abstract] [Full Text] [PDF]
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W. S. Aronow Management of Peripheral Arterial Disease of the Lower Extremities in Elderly Patients J. Gerontol. A Biol. Sci. Med. Sci., February 1, 2004; 59(2): M172 - 177. [Abstract] [Full Text] [PDF]
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 F. J. Nieto, D. M. Herrington, S. Redline, E. J. Benjamin, and J. A. Robbins Sleep Apnea and Markers of Vascular Endothelial Function in a Large Community Sample of Older Adults Am. J. Respir. Crit. Care Med., February 1, 2004; 169(3): 354 - 360. [Abstract] [Full Text] [PDF]
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A. M. O'Hare, D. V. Glidden, C. S. Fox, and C.-y. Hsu High Prevalence of Peripheral Arterial Disease in Persons With Renal Insufficiency: Results From the National Health and Nutrition Examination Survey 1999-2000 Circulation, January 27, 2004; 109(3): 320 - 323. [Abstract] [Full Text] [PDF]
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H.-H. S. Oei, R. Vliegenthart, A. Hofman, M. Oudkerk, and J. C.M. Witteman Risk factors for coronary calcification in older subjects: The Rotterdam Coronary Calcification Study Eur. Heart J., January 1, 2004; 25(1): 48 - 55. [Abstract] [Full Text] [PDF]
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M. S. Edwards, K. J. Hansen, T. E. Craven, A. J. Bleyer, G. L. Burke, P. J. Levy, and R. H. Dean Associations Between Renovascular Disease and Prevalent Cardiovascular Disease in the Elderly: A Population-Based Study Vascular and Endovascular Surgery, January 1, 2004; 38(1): 25 - 35. [Abstract] [PDF]
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P. A. VanderLaan, C. A. Reardon, and G. S. Getz Site Specificity of Atherosclerosis: Site-Selective Responses to Atherosclerotic Modulators Arterioscler Thromb Vasc Biol, January 1, 2004; 24(1): 12 - 22. [Abstract] [Full Text] [PDF]
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 C. Rucker-Whitaker, J. Feinglass, and W. H. Pearce Explaining Racial Variation in Lower Extremity Amputation: A 5-Year Retrospective Claims Data and Medical Record Review at an Urban Teaching Hospital Arch Surg, December 1, 2003; 138(12): 1347 - 1351. [Abstract] [Full Text] [PDF]
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 A Theodoridou, L Bento, D P D'Cruz, M A Khamashta, and G R V Hughes Prevalence and associations of an abnormal ankle-brachial index in systemic lupus erythematosus: a pilot study Ann Rheum Dis, December 1, 2003; 62(12): 1199 - 1203. [Abstract] [Full Text] [PDF]
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R. S Dieter, J. Tomasson, T. Gudjonsson, R. L Brown, M. Vitcenda, J. Einerson, and P. E McBride Lower extremity peripheral arterial disease in hospitalized patients with coronary artery disease Vascular Medicine, November 1, 2003; 8(4): 233 - 236. [Abstract] [PDF]
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I. J Kullo, K. R Bailey, S. L. Kardia, T. H Mosley Jr, E. Boerwinkle, and S. T Turner Ethnic differences in peripheral arterial disease in the NHLBI Genetic Epidemiology Network of Arteriopathy (GENOA) study Vascular Medicine, November 1, 2003; 8(4): 237 - 242. [Abstract] [PDF]
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A. B. Newman, A. M. Arnold, B. L. Naydeck, L. P. Fried, G. L. Burke, P. Enright, J. Gottdiener, C. Hirsch, D. O'Leary, and R. Tracy "Successful Aging": Effect of Subclinical Cardiovascular Disease Arch Intern Med, October 27, 2003; 163(19): 2315 - 2322. [Abstract] [Full Text] [PDF]
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