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A High Ankle-Brachial Index Is Associated With Increased Cardiovascular Disease Morbidity and Lower Quality of Life Matthew A. Allison, William R. Hiatt, Alan T. Hirsch, Joseph R. Coll, and Michael H. Criqui J. Am. Coll. Cardiol. 2008;51;1292-1298 doi:10.1016/j.jacc.2007.11.064

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Journal of the American College of Cardiology © 2008 by the American College of Cardiology Foundation Published by Elsevier Inc.

Vol. 51, No. 13, 2008 ISSN 0735-1097/08/$34.00 doi:10.1016/j.jacc.2007.11.064

PeripheralVascular Disease

A High Ankle-Brachial Index Is Associated With Increased Cardiovascular Disease Morbidity and Lower Quality of Life
Matthew A. Allison, MD, MPH,* William R. Hiatt, MD,‡ Alan T. Hirsch, MD, ¶ Joseph R. Coll, PHD,§ Michael H. Criqui, MD, MPH*† San Diego, California; Denver, Colorado; Minneapolis, Minnesota
Objectives Background
The purpose of this study is to determine if anankle-brachial index (ABI) ity of life (QoL). 1.40 is associated with reduced qual-

Ankle-brachial index values 1.40 have been associated with some cardiovascular disease (CVD) risk factors and increased mortality, but the relationship to other disease morbidity such as reduced QoL has not been previously evaluated. The PARTNERS (PAD Awareness, Risk and Treatment: New Resources for Survival)program was a national cross-sectional study of 7,155 patients age 50 years recruited from 350 primary care sites. All sites performed the ABI using a Doppler device and a standardized technique. A total of 296 subjects had an ABI 1.40 in at least 1 leg, and 4,420 had an ABI between 0.90 and 1.40. Diabetes, male gender, and waist circumference were positively associated with a high ABI, and smokingand dyslipidemia were inversely associated with a high ABI. After adjustment for age, gender, and the traditional CVD risk factors, and accounting for multiple comparisons, the high ABI group had significantly higher odds for foot ulcers (p 0.005) and borderline associations with heart failure, stroke, and neuropathy. After the same adjustments and adjusting for patients with other CVD, the high ABIgroup scored 2.0 points lower on the physical component scale on the Medical Outcomes Study Standard Form–36 and 5.5 points lower on the Walking Impairment Questionnaire walking distance domain (p 0.05 for both). Individuals with a high ABI have higher odds for foot ulcers and neuropathy, as well as lower scores on some physical functioning QoL domains. (J Am Coll Cardiol 2008;51:1292–8) © 2008by the American College of Cardiology Foundation

Methods

Results

Conclusion

The ankle-brachial index (ABI) provides information on the presence of systemic atherosclerosis and associated cardiovascular risk. For example, individuals with an ABI 0.90 have an elevated risk for incident cardiovascular disease (CVD) morbidity (1,2) and mortality events (3–5). Recent studies indicate,however, that dichotomizing the ABI using the 0.90 cut point may lead to underdiagnosis, because
From the *Department of Family and Preventive Medicine and †Department of Medicine, University of California San Diego, San Diego, California; ‡Department of Medicine and §Department of Preventive Medicine and Biostatistics, University of Colorado School of Medicine and the Colorado Prevention Center,Denver, Colorado; and the Vascular Medicine Program, Minneapolis Heart Institute Foundation, and ¶Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota. This work was supported in part by a grant from the Bristol-Myers Squibb–Sanofi-Aventis Partnership and the American Heart Association (Dr. Allison). Dr. Hiatt has received grant support...