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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.2007.11.064Peripheral Vascular 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

The purpose of this study is to determineif an ankle-brachial index (ABI)
ity of life (QoL).

Background

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.

Methods

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.

Results

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 smoking and 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 otherCVD, the high ABI group 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).

Conclusion

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 AmColl Cardiol 2008;51:1292–8) © 2008 by the American College of
Cardiology Foundation

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 PreventionCenter, 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...