doi: 10.1161/01.CIR.0000112642.63927.54
(Circulation. 2004;109:733-739.)
© 2004 American Heart Association, Inc.
Clinical Investigation and Reports |
Relationship of High and Low Ankle Brachial Index to All-Cause and Cardiovascular Disease Mortality
The Strong Heart Study
From MedStar Research Institute (H.E.R., R.S.L., K.L.J., B.V.H.), Hyattsville, Md; Department of Medicine and Preventive Medicine (M.M.M.), Feinberg School of Medicine, Northwestern University, Chicago, Ill; Cornell University Medical Center (R.B.D.), New York, NY; and National Heart, Lung, and Blood Institute (R.R.F.), Bethesda, Md.
Correspondence to Helaine E. Resnick, PhD, MPH, Director, Department of Epidemiology, MedStar Research Institute, 6495 New Hampshire Ave, Suite 201, Hyattsville, MD 20873. E-mail helaine.e.resnick{at}medstar.net
Received June 20, 2003; de novo received September 23, 2003; revision received November 5, 2003; accepted November 6, 2003.
Background— The associations of low (<0.90) and high (>1.40) ankle brachial index (ABI) with risk of all-cause and cardiovascular disease (CVD) mortality have not been examined in a population-based setting.
Methods and Results— We examined all-cause and CVD mortality in relation to low and high ABI in 4393 American Indians in the Strong Heart Study. Participants had bilateral ABI measurements at baseline and were followed up for 8.3±2.2 years (36 589 person-years). Cox regression was used to quantify mortality rates among participants with high and low ABI relative to those with normal ABI (0.90 
ABI 1.40). Death from all causes occurred in 1022 participants (23.3%; 27.9 deaths per 1000 person-years), and of these, 272 (26.6%; 7.4 deaths per 1000 person-years) were attributable to CVD. Low ABI was present in 216 participants (4.9%), and high ABI occurred in 404 (9.2%). Diabetes, albuminuria, and hypertension occurred with greater frequency among persons with low (60.2%, 44.4%, and 50.1%) and high (67.8%, 49.9%, and 45.1%) ABI compared with those with normal ABI (44.4%, 26.9%, and 36.5%), respectively (P<0.0001). Adjusted risk estimates for all-cause mortality were 1.69 (1.34 to 2.14) for low and 1.77 (1.48 to 2.13) for high ABI, and estimates for CVD mortality were 2.52 (1.74 to 3.64) for low and 2.09 (1.49 to 2.94) for high ABI.
Conclusions— The association between high ABI and mortality was similar to that of low ABI and mortality, highlighting a U-shaped association between this noninvasive measure of peripheral arterial disease and mortality risk. Our data suggest that the upper limit of normal ABI should not exceed 1.40.
Key Words: epidemiology • mortality • peripheral vascular disease
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