The ankle-brachial index in the elderly and risk of stroke, coronary disease, and death: the Framingham Study

• Published in: Archives of internal medicine (1960) Vol. 163; no. 16; p. 1939
• Main Authors: Murabito, Joanne M, Evans, Jane C, Larson, Martin G, Nieto, Kenneth, Levy, Daniel, Wilson, Peter W F
• Format: Journal Article
• Language: English
• Published: United States 08.09.2003
• Subjects: Aged; Aged, 80 and over; Ankle; Blood Pressure; Blood Pressure Determination - methods; Brachial Artery - physiology; Coronary Disease - diagnosis; Coronary Disease - mortality; Coronary Disease - physiopathology; Female; Humans; Leg - blood supply; Leg - physiology; Male; Peripheral Vascular Diseases - diagnosis; Peripheral Vascular Diseases - mortality; Peripheral Vascular Diseases - physiopathology; Predictive Value of Tests; Risk Factors; Severity of Illness Index; Stroke - diagnosis; Stroke - mortality; Stroke - physiopathology
• ISSN: 0003-9926
• DOI: 10.1001/archinte.163.16.1939

A low ankle-brachial index (ABI) is associated with an increased risk of death and cardiovascular disease. Limited data exist regarding the relation between a low ABI and stroke. We sought to examine the relation between a low ABI and stroke, coronary heart disease, and death in the elderly. We examined 251 men and 423 women with a mean age of 80 years who had a Framingham Study examination from 1994 to 1995. A low ABI was defined as less than 0.9. Persons were followed up for 4 years for occurrence of stroke or transient ischemic attack, coronary disease, and death. Cox proportional hazards models were used to assess the relation between a low ABI and each outcome after adjusting for age, sex, and prevalent cardiovascular disease. A low ABI was detected in 20% of our sample. Only 18% of the participants with a low ABI reported claudication symptoms. One third of those with a normal ABI and 55% of those with a low ABI had cardiovascular disease at baseline. Results of multivariable Cox proportional hazards analysis demonstrated a statistically significant increase in the risk of stroke or transient ischemic attack in persons with a low ABI (hazards ratio, 2.0; 95% confidence interval, 1.1-3.7). No significant relation between a low ABI and coronary heart disease (hazards ratio, 1.2; 95% confidence interval, 0.7-2.1) or death (hazards ratio, 1.4; 95% confidence interval, 0.9-2.1) was observed. A low ABI is associated with risk of stroke or transient ischemic attack in the elderly. These results need to be confirmed in larger studies.