The Ankle-Brachial Index and Incident Cardiovascular Events in the MESA (Multi-Ethnic Study of Atherosclerosis)

被引:256
|
作者
Criqui, Michael H. [1 ]
McClelland, Robyn L. [2 ]
McDermott, Mary M. [3 ]
Allison, Matthew A.
Blumenthal, Roger S. [4 ]
Aboyans, Victor [5 ]
Ix, Joachim H.
Burke, Gregory L. [6 ]
Liu, Kaing [3 ]
Shea, Steven [7 ]
机构
[1] Univ Calif San Diego, Sch Med, Dept Family & Prevent Med, La Jolla, CA 92093 USA
[2] Univ Washington, Dept Biostat, Seattle, WA 98195 USA
[3] Northwestern Univ, Feinberg Sch Med, Chicago, IL 60611 USA
[4] Johns Hopkins Univ, Sch Med, Baltimore, MD USA
[5] Dupuytren Univ Hosp, Dept Cardiovasc Surg & Vasc Med, Limoges, France
[6] Wake Forest Univ Hlth Sci, Dept Publ Hlth Sci, Winston Salem, NC USA
[7] Columbia Univ, Sch Med, New York, NY USA
关键词
ankle-brachial index; atherosclerosis; cardiovascular events; peripheral arterial disease; risk factors; subclinical; PERIPHERAL ARTERIAL-DISEASE; RISK-FACTORS; OLDER-ADULTS; PREVALENCE; MORTALITY; ASSOCIATION; PREDICTION; REGRESSION; PRESSURES; MORBIDITY;
D O I
10.1016/j.jacc.2010.04.060
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objectives The purpose of this study was to examine the association of both a low and a high ankle-brachial index (ABI) with incident cardiovascular events in a multiethnic cohort. Background Abnormal ABIs, both low and high, are associated with elevated cardiovascular disease (CVD) risk. However, it is unknown whether this association is consistent across different ethnic groups, and whether it is independent of both newer biomarkers and other measures of subclinical atherosclerotic CVD. Methods A total of 6,647 non-Hispanic white, African-American, Hispanic, and Chinese men and women age 45 to 84 years from free-living populations in 6 U. S. field centers and free of clinical CVD at baseline had extensive measures of traditional and newer biomarker risk factors, and measures of subclinical CVD, including the ABI. Incident CVD, defined as coronary disease, stroke, or other atherosclerotic CVD death, was determined over a mean follow-up of 5.3 years. Results Both a low (<1.00) and a high (>= 1.40) ABI were associated with incident CVD events. Sex-and ethnic-specific analyses showed consistent results. Hazard ratios were 1.77 (p < 0.001) for a low and 1.85 (p = 0.050) for a high ABI after adjustment for both traditional and newer biomarker CVD risk factors, and the ABI significantly improved risk discrimination. Further adjustment for coronary artery calcium score, common and internal carotid intimal medial thickness, and major electrocardiographic abnormalities only modestly attenuated these hazard ratios. Conclusions In this study, both a low and a high ABI were associated with elevated CVD risk in persons free of known CVD, independent of standard and novel risk factors, and independent of other measures of subclinical CVD. Further research should address the cost effectiveness of measuring the ABI in targeted population groups. (J Am Coll Cardiol 2010;56:1506-12) (C) 2010 by the American College of Cardiology Foundation
引用
收藏
页码:1506 / 1512
页数:7
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