title: Mortality over four years in SHEP participants with a low ankle-arm index.
abstract: OBJECTIVE
  To assess the risk of total and cardiovascular mortality in older adults with systolic hypertension and with a low ankle-arm index (AAI) as a marker of subclinical peripheral arterial disease (PAD).
  
  
  METHODS
  Prospective observational study
  
  
  METHODS
  A subgroup of 1537 participants in the Systolic Hypertension in the Elderly Program (SHEP) were screened for lower extremity arterial disease using the AAI. Participants were evaluated at 4 years to determine vital status and cause of death. Total and cardiovascular disease (CVD) mortality rates were assessed in relationship to clinical CVD at baseline, cardiovascular risk factors and the presence of a low AAI (subclinical PAD).
  
  
  RESULTS
  Total mortality rates increased as the AAI decreased in those with and without clinical CVD at baseline. In those without clinical CVD at baseline, the presence of an AAI < or = .9 was associated with an age-adjusted relative risk (RR) of 3.00 for total mortality in men and 2.67 in women. Results were similar for CVD mortality and persisted after adjustment for cardiovascular risk factors including the presence of an abnormal electrocardiogram.
  
  
  CONCLUSIONS
  A low ankle arm-index predicted a two to three-fold increase in total and cardiovascular mortality in older adults with systolic hypertension of risk for incident cardiovascular disease. In this study of older adults with systolic hypertension, 19.7% of the participants had subclinical PAD. Risk factor modification could be targeted to older adults based on markers of asymptomatic atherosclerosis.
authors.affiliation: Department of Medicine, University of Pittsburgh, Pennsylvania 15213, USA.
authors.forename: A B
authors.initials: AB
authors.lastname: Newman
authors.forename: K S
authors.initials: KS
authors.lastname: Tyrrell
authors.forename: L H
authors.initials: LH
authors.lastname: Kuller
mesh_terms: D000368:Aged; D000842:Ankle; D001132:Arm; D002318:Cardiovascular Diseases / Q000145:classification / Q000401:mortality*; D004562:Electrocardiography; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000175:diagnosis; D008297:Male; D015337:Multicenter Studies as Topic; D016491:Peripheral Vascular Diseases / Q000175:diagnosis / Q000401:mortality; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D013599:Systole