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Ankle brachial index, C-reactive protein, and central augmentation index to identify individuals with severe
Nikolaj Eldrup1, Henrik Sillesen, Eva Prescott
1Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark.
Insights
The ankle-brachial index effectively identifies individuals with severe atherosclerosis in the general population. Other markers like C-reactive protein and central augmentation index were less effective when used in specific categories.
Area of Science:
- Cardiovascular Medicine
- Biomarkers
- Epidemiology
Background:
- Severe atherosclerosis, defined as ischaemic cardiovascular disease, poses a significant health burden.
- Identifying individuals with severe atherosclerosis in the general population is crucial for early intervention.
- Existing diagnostic tools require further evaluation for their efficacy in population-based screening.
Purpose of the Study:
- To assess the ability of ankle-brachial index (ABI), C-reactive protein (CRP), and central augmentation index (cAI) to identify individuals with severe atherosclerosis.
- To determine if these markers improve the identification of severe atherosclerosis when used in combination.
- To evaluate the predictive value of these markers on a continuous scale.
Main Methods:
- A study of 4159 randomly sampled individuals from the Danish general population.
- Severe atherosclerosis was diagnosed as ischaemic cardiovascular disease.
- Statistical analysis included odds ratios and receiver operating characteristic (ROC) curves, adjusted for age and gender.
Main Results:
- Ankle-brachial index values of 0.71-0.90 and <0.70 were associated with increased odds of severe atherosclerosis (OR 1.6 and 2.9, respectively).
- C-reactive protein and central augmentation index, when categorized, did not identify individuals with severe atherosclerosis.
- On a continuous scale, ABI, CRP, and cAI all significantly predicted severe atherosclerosis, with no significant difference in their predictive curves.
Conclusions:
- Ankle-brachial index <0.9 is a reliable indicator of severe atherosclerosis in the general population.
- Categorized C-reactive protein and central augmentation index were not effective for identifying severe atherosclerosis.
- All three markers demonstrated predictive capability for severe atherosclerosis when analyzed continuously.
Objectives:
We examined the ability of ankle brachial index, C-reactive protein and central augmentation index to identify individuals in the general population with severe atherosclerosis, diagnosed as those with ischaemic cardiovascular disease.
Methods And Results:
We examined 4159 randomly sampled individuals from the Danish general population, of which 250 had severe atherosclerosis. After adjustment for gender and age, individuals with ankle brachial index of 0.71-0.90 and <0.70 vs. 0.91-1.10 had odds ratios for severe atherosclerosis of 1.6 (95%CI:1.1-2.3) and 2.9 (1.9-4.6), respectively. C-reactive protein of >3.0 or 1.0-3.0 mg/L vs. <1.0 mg/L as well as central augmentation index in quintiles did not identify individuals with severe atherosclerosis, and did not improve further the ability of ankle brachial index to identify such individuals. On a continuous scale using receiver operating characteristics curves, presence of severe atherosclerosis was predicted by ankle brachial index (P=0.00000003), C-reactive protein (P=0.000003), as well as central augmentation index (P=0.001); these three curves did not differ.
Conclusion:
Ankle brachial index <0.9 identify individuals with severe atherosclerosis in the general population, while C-reactive protein in three groups and central augmentation index in quintiles did not. On a continuous scale, all three variables predicted severe atherosclerosis.
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