Abstract
Background
Ankle brachial index (ABI) as a risk-enhancing factor in addition to the pooled cohort
equation (PCE) in assessing cardiovascular risk for primary prevention of atherosclerotic
cardiovascular disease (ASCVD) is uncertain.
Methods
We analyzed data from the 1999–2004 National Health and Nutrition Examination Survey
(NHANES), for 5130 participants, aged 40 and older, without known cardiovascular disease
or diabetes, with available data on standard ASCVD risk and ABI. Prevalence of low
ABI (ABI<0.9) and all-cause mortality in persons with low, borderline and intermediate
ASCVD risk categories using PCE was assessed.
Results
The overall prevalence of low ABI was 3.1%. The participants with low ABI were predominantly
clustered in the intermediate (33%) and high (33%) ASCVD risk categories while most
participants with a normal ABI were in the low (56%) and intermediate (23%) risk categories.
All-cause mortality was higher among participants with low ABI compared to those with
a normal ABI in both the intermediate/borderline and high-risk categories, p<0.001 but not in the low-risk ASCVD category, p = 0.323.
Conclusions
Using the PCE, two-third of the participants with low ABI were classified as having
a low, borderline or intermediate risk of ASCVD. Low ABI was associated with an increased
all-cause mortality in the overall cohort and specifically among those with a borderline/intermediate
or high risk of ASCVD but not in those with a low risk of ASCVD. Our study supports
consideration of ABI as a risk enhancer for primary prevention among patients classified
as borderline or intermediate risk of ASCVD.
Keywords
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Article info
Publication history
Published online: September 20, 2022
Accepted:
August 9,
2022
Received:
September 29,
2021
Identification
Copyright
© 2022 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.
