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The association of the ankle-brachial index with incident coronary heart disease: the Atherosclerosis Risk In Communities (ARIC) study, 1987-2001.

Abstract

BACKGROUND

Peripheral arterial disease (PAD), defined by a low ankle-brachial index (ABI), is associated with an increased risk of cardiovascular events, but the risk of coronary heart disease (CHD) over the range of the ABI is not well characterized, nor described for African Americans.

METHODS

The ABI was measured in 12186 white and African American men and women in the Atherosclerosis Risk in Communities Study in 1987-89. Fatal and non-fatal CHD events were ascertained through annual telephone contacts, surveys of hospital discharge lists and death certificate data, and clinical examinations, including electrocardiograms, every 3 years. Participants were followed for a median of 13.1 years. Age- and field-center-adjusted hazard ratios (HRs) were estimated using Cox regression models.

RESULTS

Over a median 13.1 years follow-up, 964 fatal or non-fatal CHD events accrued. In whites, the age- and field-center-adjusted CHD hazard ratio (HR, 95% CI) for PAD (ABI<0.90) was 2.81 (1.77-4.45) for men and 2.05 (1.20-3.53) for women. In African Americans, the HR for men was 4.86 (2.76-8.47) and for women was 2.34 (1.26-4.35). The CHD risk increased exponentially with decreasing ABI as a continuous function, and continued to decline at ABI values > 1.0, in all race-gender subgroups. The association between the ABI and CHD relative risk was similar for men and women in both race groups. A 0.10 lower ABI increased the CHD hazard by 25% (95% CI 17-34%) in white men, by 20% (8-33%) in white women, by 34% (19-50%) in African American men, and by 32% (17-50%) in African American women.

CONCLUSION

African American members of the ARIC cohort had higher prevalences of PAD and greater risk of CHD associated with ABI-defined PAD than did white participants. Unlike in other cohorts, in ARIC the CHD risk failed to increase at high (>1.3) ABI values. We conclude that at this time high ABI values should not be routinely considered a marker for increased CVD risk in the general population. Further research is needed on the value of the ABI at specific cutpoints for risk stratification in the context of traditional risk factors.

Authors+Show Affiliations

Duke Clinical Research Institute, Duke University Medical Center, P,O, Box 17969, Durham, NC 27715, USA. beth.weatherley@duke.eduNo affiliation info availableNo 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, N.I.H., Extramural

Language

eng

PubMed ID

17227586

Citation

Weatherley, Beth D., et al. "The Association of the Ankle-brachial Index With Incident Coronary Heart Disease: the Atherosclerosis Risk in Communities (ARIC) Study, 1987-2001." BMC Cardiovascular Disorders, vol. 7, 2007, p. 3.
Weatherley BD, Nelson JJ, Heiss G, et al. The association of the ankle-brachial index with incident coronary heart disease: the Atherosclerosis Risk In Communities (ARIC) study, 1987-2001. BMC Cardiovasc Disord. 2007;7:3.
Weatherley, B. D., Nelson, J. J., Heiss, G., Chambless, L. E., Sharrett, A. R., Nieto, F. J., ... Rosamond, W. D. (2007). The association of the ankle-brachial index with incident coronary heart disease: the Atherosclerosis Risk In Communities (ARIC) study, 1987-2001. BMC Cardiovascular Disorders, 7, p. 3.
Weatherley BD, et al. The Association of the Ankle-brachial Index With Incident Coronary Heart Disease: the Atherosclerosis Risk in Communities (ARIC) Study, 1987-2001. BMC Cardiovasc Disord. 2007 Jan 16;7:3. PubMed PMID: 17227586.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The association of the ankle-brachial index with incident coronary heart disease: the Atherosclerosis Risk In Communities (ARIC) study, 1987-2001. AU - Weatherley,Beth D, AU - Nelson,Jeanenne J, AU - Heiss,Gerardo, AU - Chambless,Lloyd E, AU - Sharrett,A Richey, AU - Nieto,F Javier, AU - Folsom,Aaron R, AU - Rosamond,Wayne D, Y1 - 2007/01/16/ PY - 2006/09/01/received PY - 2007/01/16/accepted PY - 2007/1/18/pubmed PY - 2007/2/21/medline PY - 2007/1/18/entrez SP - 3 EP - 3 JF - BMC cardiovascular disorders JO - BMC Cardiovasc Disord VL - 7 N2 - BACKGROUND: Peripheral arterial disease (PAD), defined by a low ankle-brachial index (ABI), is associated with an increased risk of cardiovascular events, but the risk of coronary heart disease (CHD) over the range of the ABI is not well characterized, nor described for African Americans. METHODS: The ABI was measured in 12186 white and African American men and women in the Atherosclerosis Risk in Communities Study in 1987-89. Fatal and non-fatal CHD events were ascertained through annual telephone contacts, surveys of hospital discharge lists and death certificate data, and clinical examinations, including electrocardiograms, every 3 years. Participants were followed for a median of 13.1 years. Age- and field-center-adjusted hazard ratios (HRs) were estimated using Cox regression models. RESULTS: Over a median 13.1 years follow-up, 964 fatal or non-fatal CHD events accrued. In whites, the age- and field-center-adjusted CHD hazard ratio (HR, 95% CI) for PAD (ABI<0.90) was 2.81 (1.77-4.45) for men and 2.05 (1.20-3.53) for women. In African Americans, the HR for men was 4.86 (2.76-8.47) and for women was 2.34 (1.26-4.35). The CHD risk increased exponentially with decreasing ABI as a continuous function, and continued to decline at ABI values > 1.0, in all race-gender subgroups. The association between the ABI and CHD relative risk was similar for men and women in both race groups. A 0.10 lower ABI increased the CHD hazard by 25% (95% CI 17-34%) in white men, by 20% (8-33%) in white women, by 34% (19-50%) in African American men, and by 32% (17-50%) in African American women. CONCLUSION: African American members of the ARIC cohort had higher prevalences of PAD and greater risk of CHD associated with ABI-defined PAD than did white participants. Unlike in other cohorts, in ARIC the CHD risk failed to increase at high (>1.3) ABI values. We conclude that at this time high ABI values should not be routinely considered a marker for increased CVD risk in the general population. Further research is needed on the value of the ABI at specific cutpoints for risk stratification in the context of traditional risk factors. SN - 1471-2261 UR - https://www.unboundmedicine.com/medline/citation/17227586/The_association_of_the_ankle_brachial_index_with_incident_coronary_heart_disease:_the_Atherosclerosis_Risk_In_Communities__ARIC__study_1987_2001_ L2 - https://bmccardiovascdisord.biomedcentral.com/articles/10.1186/1471-2261-7-3 DB - PRIME DP - Unbound Medicine ER -