title: Risk factors for declining ankle-brachial index in men and women 65 years or older: the Cardiovascular Health Study.
abstract: BACKGROUND
  An ankle-brachial index (ABI) of less than 0.9 is a noninvasive measure of lower extremity arterial disease and a predictor of cardiovascular events. Little information is available on longitudinal change in ABI or on risk factors for declining ABI in a community-based population.
  
  
  METHODS
  To assess risk factors for ABI decline, we studied 5888 participants in the Cardiovascular Health Study cohort (men and women 65 years or older). We measured ABI in 1992-1993 and again in 1998-1999. At baseline, we excluded individuals with an ABI less than 0.9, ABI greater than 1.4, or confirmed symptomatic lower extremity arterial disease (n = 823). The group with ABI decline included 218 participants with decline greater than 0.15 and to 0.9 or less. The comparison group comprised the remaining 2071 participants with follow-up ABI.
  
  
  RESULTS
  The percentage of participants with ABI decline was 9.5% over 6 years of follow-up. The mean +/- SD decline was 0.33 +/- 0.12 in cases of ABI decline and 0.02 +/- 0.13 in non-cases. Independent predictors of ABI decline, reported as odds ratios, were age, 1.96 (95% confidence interval [CI], 1.42-2.71) for 75 to 84 years and 3.79 (95% CI, 1.36-10.5) for those older than 85 years compared with those younger than 75 years; current cigarette use, 1.74 (95% CI, 1.02-2.96); hypertension, 1.64 (95% CI, 1.18-2.28); diabetes, 1.77 (95% CI, 1.14-2.76); higher low-density lipoprotein cholesterol level, 1.60 (95% CI, 1.03-2.51), and lipid-lowering drug use 1.74 (95% CI, 1.05-2.89).
  
  
  CONCLUSIONS
  Worsening lower extremity arterial disease, assessed as ABI decline, occurred in 9.5% of this elderly cohort over 6 years and was associated with modifiable vascular disease risk factors.
authors.affiliation: Department of Medicine, University of Vermont, Burlington, USA.
authors.forename: Margaret
authors.initials: M
authors.lastname: Kennedy
authors.forename: Cam
authors.initials: C
authors.lastname: Solomon
authors.forename: Teri A
authors.initials: TA
authors.lastname: Manolio
authors.forename: Michael H
authors.initials: MH
authors.lastname: Criqui
authors.forename: Anne B
authors.initials: AB
authors.lastname: Newman
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Polak
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Burke
authors.forename: Paul
authors.initials: P
authors.lastname: Enright
authors.forename: Mary
authors.initials: M
authors.lastname: Cushman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000842:Ankle / Q000098:blood supply*; D001916:Brachial Artery; D002318:Cardiovascular Diseases / Q000175:diagnosis; D005260:Female; D006801:Humans; D008297:Male; D016491:Peripheral Vascular Diseases / Q000175:diagnosis*; D018570:Risk Assessment; D012307:Risk Factors