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Adding low ankle brachial index to classical risk factors improves the prediction of major cardiovascular events. The

A Velescu1, A Clara2, J Peñafiel3

  • 1Angiology and Vascular Surgery Department, Hospital del Mar, Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Universitat Autònoma de Barcelona, Spain.

Atherosclerosis
|June 15, 2015
PubMed

Insights

Adding the ankle-brachial index (ABI) to the Framingham-REGICOR risk function significantly improves cardiovascular disease (CVD) prediction. This simple test enhances risk stratification, supporting its use in primary prevention strategies.

Area of Science:

  • Cardiology
  • Preventive Medicine
  • Biomarker Research

Background:

  • Cardiovascular risk estimation is crucial for primary prevention but current methods have limited accuracy.
  • Novel biomarkers are investigated to enhance prediction of coronary heart disease (CHD) and cardiovascular disease (CVD).
  • The ankle-brachial index (ABI) is a potential biomarker for assessing peripheral artery disease and cardiovascular risk.

Purpose of the Study:

  • To evaluate if incorporating the ankle-brachial index (ABI) improves the predictive performance of the Framingham-REGICOR risk function.
  • To assess ABI's utility in a population with low incidence of cardiovascular disease (CVD).

Main Methods:

  • A prospective population-based cohort study followed 5248 individuals (aged 35-74) for a median of 5.9 years.
  • Baseline ankle-brachial index (ABI) was measured using a standardized method.
  • Improvements in prediction were assessed using discrimination (ΔC-statistics) and reclassification (net reclassification index, NRI).

Main Results:

  • A pathological ABI (≤0.9) was significantly associated with increased CHD and CVD risk (HR: 2.08 and 2.24, respectively; p<0.001).
  • Inclusion of ABI improved discrimination (ΔC-statistic: 0.007) and reclassification (NRI: 0.029) for CVD events (p<0.001).
  • ABI did not significantly improve prediction for coronary heart disease (CHD) events alone.

Conclusions:

  • The ankle-brachial index (ABI) enhances the predictive accuracy of the Framingham-REGICOR risk function, particularly for overall CVD events.
  • The findings support the value of integrating ABI into cardiovascular risk stratification protocols.
  • This simple, non-invasive test aligns with recommendations for improving cardiovascular risk assessment in primary prevention.
Abstract

Keywords:
Ankle brachial indexCardiovascular riskRisk function

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