Key result
Low ankle-brachial index (<0.90) was independently associated with a more than twofold increased risk of major adverse cardiovascular events (HR 2.43) compared to normal index over an 8.7-year follow-up.
Why the study?
Few studies have examined long-term cardiovascular outcomes associated with borderline ankle-brachial index, particularly within the general population.
Does low or borderline ankle-brachial index predict incident cardiovascular outcomes in a low-risk Mediterranean population?
Cohort (n=3,146)
Yes
Does low or borderline ankle-brachial index predict incident cardiovascular outcomes in a low-risk Mediterranean population?
Hazard Ratio: 2.43 (95% CI 1.67–3.56)
Absolute Event Rate: 26.9% vs 5.6%
p-value: p=<0.001
In a low-risk Mediterranean population, low ABI strongly predicts major cardiovascular events, while borderline ABI is an independent predictor of incident coronary disease and future peripheral artery disease.
May aid risk stratification in low-risk Mediterranean adults; extends ABI evidence to this population but remains hypothesis-generating.
BACKGROUND: Guidelines recommended adopting the same cardiovascular risk modification strategies used for coronary disease in case of low Ankle-brachial index (ABI), but here exist few studies on long-term cardiovascular outcomes in patients with borderline ABI and even fewer on the general population. AIM: The aim of the present study was to analyze the relationship between long-term cardiovascular events and low, borderline and normal ABI after a 9-year follow up of a Mediterranean population with low cardiovascular risk. DESIGN AND SETTING: A population-based prospective cohort study was performed in the province of Barcelona, Spain. METHOD: A total of 3,786 subjects >49 years were recruited from 2006-2008. Baseline ABI was 1.08 ± 0.16. Subjects were followed from the time of enrollment to the end of follow-up in 2016 via phone calls every 6 months, systematic reviews of primary-care and hospital medical records and analysis of the SIDIAP (Information System for Primary Care Research) database to confirm the possible appearance of cardiovascular events. RESULTS: 3146 individuals participated in the study. 2,420 (77%) subjects had normal ABI, 524 (17%) had borderline ABI, and 202 (6.4%) had low ABI. In comparison with normal and borderline subjects, patients with lower ABI had more comorbidities, such as hypertension, hypercholesterolemia and diabetes. Cumulative MACE incidence at 9 years was 20% in patients with low ABI, 6% in borderline ABI and 5% in normal ABI. The annual MACE incidence after 9 years follow-up was significantly higher in people with low ABI (26.9/1000py) (p<0.001) than in borderline (6.6/1000py) and in normal ABI (5.6/1000py). Subjects with borderline ABI are at significantly higher risk for coronary disease (HR: 1.58; 95% CI: 1.02-2, 43; p = 0,040) compared to subjects with normal ABI, after adjustment. CONCLUSION: The results of the present study support that low ABI was independently associated with higher incidence of MACE, ICE, cardiovascular and no cardiovascular mortality; while borderline ABI had significantly moderate risk for coronary disease than normal ABI.
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Alzamora et al. (2019) conducted a cohort in Low cardiovascular risk (general population) (n=3,146). Low ankle-brachial index (<0.90) vs. Normal ankle-brachial index (1.00-1.39) was evaluated on Major adverse cardiovascular events (MACE) (HR 2.43, 95% CI 1.67-3.56, p=<0.001). Low ankle-brachial index (<0.90) was independently associated with a more than twofold increased risk of major adverse cardiovascular events (HR 2.43) compared to normal index over an 8.7-year follow-up.
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