The Relationship between Ankle‐Arm Index and Mortality in Older Men and Women

OBJECTIVE: To determine whether the ankle-arm blood pressure index is a useful predictor of mortality in a large group of patients aged 50 or older. DESIGN: Cohort study over a 13-year period. SETTING: Peripheral vascular laboratory in a hospital affiliated with an academic health center. PARTICIPANTS: 1,027 male and 903 female patients referred for arterial evaluation. OUTCOME MEASURES: All-cause and cause-specific mortality. RESULTS: A decrease in ankle-arm index was a strong independent predictor of all-cause mortality relative risk (RR) for men = 1.8(95% CI 1.5, 1.9); for women = 1.5, (1.2, 2.0) and atherosclerotic heart disease mortality RR for men = 2.0 (1.4, 2.9); for women = 2.1 (1.4, 3.1). The risk of mortality was inversely proportional to the ankle-arm index. No relationship was found between the index and mortality due to stroke or cancer. CONCLUSIONS: These results suggest that a decreased ankle-arm index has important prognostic significance for mortality due to atherosclerotic heart disease in older men and women. Measurement of this index may be useful in identifying those at high risk who may benefit from aggressive therapeutic intervention.