[Clinical value of the ankle-brachial index in patients at risk of cardiovascular disease but without known atherothrombotic disease: VITAMIN study].
OBJECTIVE
Detecting peripheral arterial disease by measuring the ankle-brachial index can help identify asymptomatic patients with established disease. We investigated the prevalence of peripheral arterial disease (i.e., an ankle-brachial index <0.9) and its potential clinical and therapeutic impact in patients with no known arterial disease who were seen at internal medicine departments.


METHODS
This multicenter, cross-sectional, observational study included patients at risk of cardiovascular disease who were selected on the basis of age, gender and the presence of conventional risk factors. No patient was known to have arterial disease.


RESULTS
The study included 493 patients, 174 (35%) of whom had diabetes, while 321 (65%) did not. Only 16% were in a low-risk category according to their Framingham score. An ankle-brachial index <0.9 was observed in 27.4%, comprising 37.9% of those with diabetes and 21.3% of those without. Multiple logistic regression analysis showed that the risk factors associated with an ankle-brachial index <0.9 were age, diabetes, and hypercholesterolemia. There was a significant relationship between the ankle-brachial index and Framingham risk categories. Therapeutically, only 21% of patients with an ankle brachial index <0.9 were taking antiplatelet drugs. Overall, 20% had a low-density lipoprotein cholesterol concentration <100 mg/dl and 52% had a concentration <130 mg/dl. Some 42% had arterial blood pressures below 140/90 mm Hg.


CONCLUSIONS
Asymptomatic peripheral arterial disease was detected in a high proportion of patients with an intermediate or high cardiovascular disease risk. The ankle-brachial index should be measured routinely in patients at risk of cardiovascular disease who are seen at internal medicine departments.
Manzano
Luis
L
Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, España. luis.manzano@uah.es
García-Díaz
Juan de D
Jde D
Gómez-Cerezo
Jorge
J
Mateos
Javier
J
del Valle
Francisco J
FJ
Medina-Asensio
Jesús
J
Viejo
Luis F
LF
Fernández-Ballesteros
Angel
A
Solís
Javier
J
Herrero Domingo
Almudena
A
Ferreira
Eva
E
Sánchez-Fuentes
Demetrio
D
Barragán
José M
JM
González-Moraleja
Julio
J
Vargas
Juan A
JA
López-Jiménez
Manuel
M
Zamora
Javier
J
D000368:Aged; D000842:Ankle; D001132:Arm; D050197:Atherosclerosis; D001795:Blood Pressure Determination / Q000379:methods*; D002318:Cardiovascular Diseases / Q000175:diagnosis*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013927:Thrombosis