Why the study?
It was unclear whether the ankle brachial pressure index is independently associated with cardiovascular morbidity and mortality in the asymptomatic general population.
Does an abnormal ankle brachial pressure index (ABPI) predict cardiovascular morbidity and mortality in the asymptomatic general population?
Does an abnormal ankle brachial pressure index (ABPI) predict cardiovascular morbidity and mortality in the asymptomatic general population?
An abnormal ankle brachial pressure index (<0.9 or >1.3) is a significant independent predictor of cardiovascular and all-cause mortality in the asymptomatic general population.
ABPI <0.9 flags higher mortality risk in asymptomatic adults; confirms its value as an independent predictor in pooled analyses.
OBJECTIVE: This study aimed to assess whether the ankle brachial pressure index (ABPI) is independently associated with cardiovascular morbidity and mortality in the asymptomatic general population. DATA SOURCES: Ovid MEDLINE, Embase, CINAHL, and Cochrane databases. REVIEW METHODS: Studies assessing ABPI in a general population with > 30 days follow up were included. A random effects meta-analysis was completed following PRISMA guidelines (PROSPERO: CRD42022383573). Study quality was assessed using the Newcastle-Ottawa Scale, and certainty was assessed through Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Outcomes included major cardiovascular events, cardiovascular death, coronary events, cerebrovascular events, and all cause death. RESULTS: Twenty-five studies from 23 cohorts were included (20 prospective, four retrospective, and one propensity matched), representing 181 598 individuals. An ABPI < 0.9 was statistically significantly associated with higher cardiovascular mortality (hazard ratio [HR] 2.04, 95% confidence interval [CI] 1.70 - 2.44, p < .001; GRADE, low certainty), major cardiovascular events (HR 1.74, 95% CI 1.56 - 1.94, p < .001; GRADE, very low certainty), coronary events (HR 2.80, 95% CI 2.11 - 3.70, p < .001; GRADE, low certainty), cerebrovascular events (HR 1.75, 95% CI 1.34 - 2.30, p < .001; GRADE, low certainty), and all cause mortality (HR 1.90, 95% CI 1.71 - 2.10, p < .001; GRADE, very low certainty) compared with a normal ABPI. An ABPI > 1.3 was statistically significantly associated with higher cardiovascular mortality (HR 2.39, 95% CI 2.02 - 2.83, p < .001; GRADE, low certainty) and all cause mortality (HR 1.92, 95% CI 1.54 - 2.39, p < .001; GRADE, very low certainty) compared with a normal ABPI. An ABPI > 1.3 was not statistically significant for major cardiovascular events (HR 1.07, 95% CI 0.74 - 1.55, p = .70; GRADE, low certainty) or cerebrovascular events (HR 1.80, 95% CI 0.91 - 3.58, p = .090; GRADE, very low certainty). CONCLUSION: An abnormal ABPI is associated with higher cardiovascular and all cause mortality rates. Randomised evidence is needed to assess the cost effectiveness, efficacy, and benefits of screening.
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Messeder et al. (2025) studied this question.
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