Key result
Low ankle-brachial index (<0.9) increased the risk of all-cause mortality compared to patients with normal ABI and no diabetes or cardiovascular disease (HR 1.42; 95% CI 1.25-1.63).
Why the study?
Cardiovascular prevention is of interest in asymptomatic peripheral arterial disease, motivating quantification of its association with mortality and cardiovascular outcomes compared to other high-risk indicators.
Does a low ankle-brachial index increase the risk of mortality and cardiovascular events compared to other major risk conditions in primary care patients?
Cohort (n=58,118)
Does a low ankle-brachial index increase the risk of mortality and cardiovascular events compared to other major risk conditions in primary care patients?
Hazard Ratio: 1.42 (95% CI 1.25–1.63)
A low ankle-brachial index is associated with increased risks of mortality, myocardial infarction, and ischemic stroke, with risks in patients having both low ABI and diabetes comparable to those with previous cardiovascular disease.
Supports ABI for mortality risk stratification in patients without diabetes or CVD; hypothesis-generating pending prospective validation.
Cardiovascular prevention is of particular interest in persons with asymptomatic peripheral arterial disease. We aimed to quantify its association with mortality and cardiovascular outcomes, compared to other indicators of high risk. We performed a retrospective cohort study using the Database of the Catalan primary care system (SIDIAPQ), for 2006–2015, including 35–85-year-old patients with an ankle–brachial index (ABI) measurement, classified according to the presence of diabetes, cardiovascular disease, and low ABI (<0.9). We calculated the incidences and hazard ratios (HRs) for all-cause mortality, acute myocardial infarction, and ischemic stroke. During a median follow-up of 5.9 years, we analyzed 58,118 persons. The mean (SD) age was 66.6 (10.7) years and 53.4% were men. Compared to the reference group with no diabetes, no previous cardiovascular disease, and normal ankle–brachial index, the HR for all-cause mortality was 1.42 (1.25–1.63) in the group with low ABI, 1.35 (1.26–1.45) in those with diabetes, 1.50 (1.34–1.69) in those with previous cardiovascular disease, and 1.84 (1.68–2.01) in those with low ABI and diabetes. In conclusion, participants with low ABI showed increased mortality, acute myocardial infarction, and ischemic stroke incidence in all the subgroups. Patients with low ankle–brachial index plus diabetes presented increased mortality, acute myocardial infarction, and ischemic stroke risk, all at rates similar to those with previous cardiovascular disease.
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Alves‐Cabratosa et al. (2019) conducted a cohort in asymptomatic peripheral arterial disease (n=58,118). Low ankle-brachial index (<0.9) vs. No diabetes, no previous cardiovascular disease, and normal ankle-brachial index was evaluated on all-cause mortality (HR 1.42, 95% CI 1.25-1.63). Low ankle-brachial index (<0.9) increased the risk of all-cause mortality compared to patients with normal ABI and no diabetes or cardiovascular disease (HR 1.42; 95% CI 1.25-1.63).
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