title: Peripheral arterial occlusive disease: prognostic value of signs, symptoms, and the ankle-brachial pressure index.
abstract: OBJECTIVE
  To determine whether different levels of the ankle-brachial pressure index (ABPI) are associated with an increased risk for progressive limb ischemia, nonfatal and fatal cardiovascular events. To investigate the prognostic value of signs and symptoms associated with peripheral arterial occlusive disease (PAOD).
  
  
  METHODS
  Prospective follow-up study.
  
  
  METHODS
  Eighteen general practice centers in the Netherlands.
  
  
  METHODS
  Three thousand six hundred forty-nine participants (53% female) with a mean age of 59 years (range: 40-78 years).
  
  
  METHODS
  Progressive limb ischemia, cardiovascular morbidity and mortality.
  
  
  RESULTS
  At baseline, 458 participants had PAOD, defined as an ABPI < 0.95. Among these, 148 (32.2%) had an ABPI < 0.70. Cox proportional hazards models showed that after a mean follow-up period of 7.2 years, PAOD patients with an ABPI < 0.70 were at higher risk for cardiovascular death, compared with participants with a moderately reduced ABPI (< 0.95 - > or = 0.70): HR 2.3 versus 1.2. Older age, complaints of intermittent claudication, abnormal pedal pulses, elevated blood pressure, and coexisting cardiovascular disease at baseline were also significant independent prognostic factors for one or more of the adverse outcome events in these patients.
  
  
  CONCLUSIONS
  The ABPI is inversely associated with cardiovascular mortality in PAOD patients. A low ABPI is an independent predictor for cardiovascular mortality in PAOD patients.
authors.affiliation: Department of General Practice Research, Institute for Extramural and Transmural Health Care, Maastricht University, The Netherlands.
authors.forename: Jurenne D
authors.initials: JD
authors.lastname: Hooi
authors.forename: Henri E J H
authors.initials: HE
authors.lastname: Stoffers
authors.forename: Arnold D M
authors.initials: AD
authors.lastname: Kester
authors.forename: Ree Jan W
authors.initials: RJ
authors.lastname: van
authors.forename: J André
authors.initials: JA
authors.lastname: Knottnerus
mesh_terms: D000368:Aged; D000842:Ankle / Q000098:blood supply*; D001794:Blood Pressure; D001916:Brachial Artery / Q000503:physiopathology*; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007383:Intermittent Claudication / Q000150:complications / Q000401:mortality / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000150:complications / Q000401:mortality / Q000503:physiopathology*; D011379:Prognosis; D011446:Prospective Studies