Ankle–brachial blood pressure in elderly men and the risk of stroke: The Honolulu Heart Program

• Published in: Journal of clinical epidemiology Vol. 54; no. 10; pp. 973 - 978
• Main Authors: Abbott, Robert D, Rodriguez, Beatriz L, Petrovitch, Helen, Yano, Katsuhiko, Schatz, Irwin J, Popper, Jordan S, Masaki, Kamal H, Ross, G.Webster, Curb, J.David
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Elsevier Inc 01.10.2001; Elsevier
• Subjects: Age Distribution; Age Factors; Aged; Aged, 80 and over; Ankle; Asian Americans - statistics & numerical data; Biological and medical sciences; Blood Pressure; Brachial Artery - physiology; Diabetes Mellitus; Hawaii - epidemiology; Health Services for the Aged; Humans; Hypertension; Incidence; Leg - blood supply; Leg - physiology; Longitudinal Studies; Male; Medical sciences; Neurology; Predictive Value of Tests; Risk Factors; Smoking; Stroke - diagnosis; Stroke - epidemiology; Stroke - genetics; Vascular diseases and vascular malformations of the nervous system; Hawaii; Human; Measurement; Sanitary program; Nervous system diseases; Stroke; Cardiovascular disease; Asymptomatic; Medical screening; Epidemiology; Cerebral disorder; Vascular disease; Concomitant disease; Central nervous system disease; Arterial pressure; Elderly; Cerebrovascular disease
• ISSN: 0895-4356; 1878-5921
• DOI: 10.1016/S0895-4356(01)00373-0

Although low ankle/brachial blood pressure index (ABI) is a marker of generalized atherosclerosis in the elderly, it has not been identified as a risk factor for stroke. The purpose of this report is to examine the relation between ABI and stroke in elderly men. ABI was measured from 1991 to 1993 in 2767 men aged 71 to 93 years in the Honolulu Heart Program without a history of stroke and coronary heart disease. Subjects were followed for 3 to 6 years for fatal and nonfatal thromboembolic and hemorrhagic stroke. During follow-up, there were 91 strokes. There was an age-adjusted 2-fold excess in men with an ABI < 0.9 (6.0%) versus men with an ABI ⩾ 0.9 (2.9%, P < 0.01). Thromboembolic events occurred in 4.6% of men with an ABI < 0.9 and in 2.0% in those with an ABI ⩾ 0.9 (P < 0.01). Hemorrhagic stroke was also more frequent in men with a low ABI (< 0.9) versus a higher ABI (1.9 vs. 0.8%, respectively). After adjusting for other factors, the risk of total and thromboembolic strokes increased with declining ABI (P = 0.019 and P = 0.004, respectively). The relation between ABI and stroke was similar and statistically significant in the presence and absence of diabetes and hypertension (P < 0.05). Findings suggest that ABI is inversely related to the incidence of stroke. Simple measurement of ABI in an outpatient setting could be an important tool for assessing the risk of stroke in the elderly.