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Abnormally High Ankle-Brachial Index is Associated with All-cause and Cardiovascular Mortality: The REGICOR Study

A Velescu1, A Clara1, R Martí2

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

European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery
|July 30, 2017
PubMed

Insights

A high ankle-brachial index (ABI) ≥ 1.4 is not linked to more cardiovascular events in individuals without prior disease. However, this subgroup shows a trend toward higher mortality, suggesting a high-risk classification.

Area of Science:

  • Vascular Medicine
  • Epidemiology
  • Cardiovascular Health

Background:

  • The clinical significance of a high ankle-brachial index (ABI) and its association with cardiovascular disease (CVD) and mortality remains debated.
  • A high ABI (≥ 1.4) may indicate increased cardiovascular risk, but evidence in populations without pre-existing CVD is limited.

Purpose of the Study:

  • To investigate the association between an abnormally high ABI (≥ 1.4) and the incidence of coronary heart disease (CHD), cerebrovascular disease, and all-cause mortality.
  • To assess cardiovascular event rates and mortality in a Mediterranean population with a high ABI but no history of CVD.

Main Methods:

  • A prospective population-based cohort study involving 6352 subjects, with a median follow-up of 6.2 years.
  • Exclusion criteria included age under 35, history of CVD, or ABI < 0.9.
  • Recording of CHD events, cerebrovascular events, and all-cause mortality.

Main Results:

  • Of 5679 eligible subjects, 2.9% had an ABI ≥ 1.4. Independent factors associated with high ABI included older age, female sex, diabetes, and lower diastolic blood pressure.
  • An ABI ≥ 1.4 was not significantly associated with a higher incidence of CV events in multivariate analysis.
  • An ABI ≥ 1.4 was independently associated with increased all-cause mortality (HR=2.0) and cardiovascular mortality (HR=3.1).

Conclusions:

  • Individuals without pre-existing CVD but with a high ABI (≥ 1.4) did not exhibit a greater rate of cardiovascular events.
  • A trend towards higher mortality risk was observed in this subgroup, supporting their classification as a high-risk population.
  • Further research may clarify the prognostic value of a high ABI in specific populations.
Abstract

Keywords:
All-cause mortalityAnkle brachial indexCardiovascular eventsCardiovascular mortality

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