Risk factors for declining ankle-brachial index in men and women 65 years or older: the Cardiovascular Health Study.
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.
Kennedy
Margaret
M
Department of Medicine, University of Vermont, Burlington, USA.
Solomon
Cam
C
Manolio
Teri A
TA
Criqui
Michael H
MH
Newman
Anne B
AB
Polak
Joseph F
JF
Burke
Gregory L
GL
Enright
Paul
P
Cushman
Mary
M
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