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Relationship of high and low ankle brachial index to all-cause and cardiovascular disease mortality: the Strong Heart Study.
Circulation. 2004 Feb 17; 109(6):733-9.Circ

Abstract

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 < or =ABI < or =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.

Authors+Show Affiliations

Department of Epidemiology, MedStar Research Institute, Hyattsville, Md 20873, USA. helaine.e.resnick@medstar.netNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

14970108

Citation

Resnick, Helaine E., et al. "Relationship of High and Low Ankle Brachial Index to All-cause and Cardiovascular Disease Mortality: the Strong Heart Study." Circulation, vol. 109, no. 6, 2004, pp. 733-9.
Resnick HE, Lindsay RS, McDermott MM, et al. Relationship of high and low ankle brachial index to all-cause and cardiovascular disease mortality: the Strong Heart Study. Circulation. 2004;109(6):733-9.
Resnick, H. E., Lindsay, R. S., McDermott, M. M., Devereux, R. B., Jones, K. L., Fabsitz, R. R., & Howard, B. V. (2004). Relationship of high and low ankle brachial index to all-cause and cardiovascular disease mortality: the Strong Heart Study. Circulation, 109(6), 733-9.
Resnick HE, et al. Relationship of High and Low Ankle Brachial Index to All-cause and Cardiovascular Disease Mortality: the Strong Heart Study. Circulation. 2004 Feb 17;109(6):733-9. PubMed PMID: 14970108.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Relationship of high and low ankle brachial index to all-cause and cardiovascular disease mortality: the Strong Heart Study. AU - Resnick,Helaine E, AU - Lindsay,Robert S, AU - McDermott,Mary McGrae, AU - Devereux,Richard B, AU - Jones,Kristina L, AU - Fabsitz,Richard R, AU - Howard,Barbara V, PY - 2004/2/19/pubmed PY - 2004/5/12/medline PY - 2004/2/19/entrez SP - 733 EP - 9 JF - Circulation JO - Circulation VL - 109 IS - 6 N2 - 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 < or =ABI < or =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. SN - 1524-4539 UR - https://www.unboundmedicine.com/medline/citation/14970108/Relationship_of_high_and_low_ankle_brachial_index_to_all_cause_and_cardiovascular_disease_mortality:_the_Strong_Heart_Study_ L2 - https://www.ahajournals.org/doi/10.1161/01.CIR.0000112642.63927.54?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -