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Published on: October 22, 2014
Implications of routinely measuring Ankle-Brachial Index (ABI) among patients attending at a Lipid Clinic
Alessandro Sona1, Monica Comba, Alessia Brescianini
1SCDU Geriatria, Dipartimento di Discipline Medico Chirurgiche, Università di Torino, Italy.
Insights
Routine Ankle Brachial Index (ABI) screening in lipid clinics identifies many patients at high cardiovascular risk. This simple test can reclassify about one-fifth of individuals initially deemed low or moderate risk, improving cardiovascular disease prevention.
Area of Science:
- Cardiology
- Vascular Medicine
- Preventive Cardiology
Background:
- Low Ankle Brachial Index (ABI) values (< or = 90) signify elevated cardiovascular disease (CV) risk and mortality.
- The impact of routine ABI measurement in Lipid Clinic settings on CV risk stratification is underexplored.
Purpose of the Study:
- To assess if routine ABI determination modifies CV risk classification in patients attending a Lipid Clinic.
- To quantify the extent of risk reclassification when ABI is added to conventional risk models.
Main Methods:
- Consecutive asymptomatic, non-diabetic individuals without prior CV events at a Lipid Clinic were included.
- ABI was measured routinely, and CV risk was assessed using the CUORE and SCORE models.
- Risk reclassification was analyzed based on ABI results in conjunction with conventional models.
Main Results:
- Out of 320 subjects, 77 (24.1%) had low ABI values.
- Approximately one-fifth of individuals classified as low or moderate risk by CUORE (16.8%) and SCORE (21.3%) models were reclassified to high risk due to low ABI.
- Low ABI prevalence was notable even in subjects with initially low or moderate calculated risk.
Conclusions:
- Routine ABI measurement in Lipid Clinics reveals a high prevalence of low ABI values in patients assessed as low or moderate risk by conventional models.
- Adding ABI testing leads to significant cardiovascular high-risk reclassification for a substantial proportion of patients.
- These findings support routine ABI determination in primary prevention settings, particularly within specialized clinics like Lipid Clinics.
Background:
Low (< or = 90) Ankle Brachial Index (ABI) values identify patients at high risk for cardiovascular (CV) disease and mortality. Implications for CV risk classification from routinely measuring ABI in the context of a Lipid Clinic have not been fully investigated. We aimed to evaluate whether and to what extent routine ABI determination on top of conventional risk prediction models may modify CV risk classification.
Methods:
Consecutive asymptomatic non-diabetic individuals free from previous CV events attending for a first visit at a Lipid Clinic underwent routine ABI determination and conventional CV risk classification according either to national CUORE model (including age, gender, smoking, total and high density lipoprotein cholesterol, systolic blood pressure and current use of blood pressure lowering drugs) and SCORE model for low risk countries.
Results:
In the overall sample (320 subjects, mean age 64.8 years) 77 subjects (24.1%) were found to have low ABI value. Forty-two of 250 subjects (16.8%) and 47 of 215 individuals (21.3%) at low or moderate risk according to the CUORE and SCORE models, respectively, were found to have low ABI values, and should be reclassified at high risk.
Conclusion:
In a series of consecutive asymptomatic individuals in a Lipid Clinic, we observed a high prevalence of low ABI values among subjects deemed at low or moderate risk on conventional prediction models, leading to CV high-risk reclassification of roughly one fifth of patients. These findings reinforce recommendations for routine determination of ABI at least within referral primary prevention settings.
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Monitoring Both Arms:
Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.