title: [Clinical value of the ankle-brachial index in patients at risk of cardiovascular disease but without known atherothrombotic disease: VITAMIN study].
abstract: 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.
authors.affiliation: Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, España. luis.manzano@uah.es
authors.forename: Luis
authors.initials: L
authors.lastname: Manzano
authors.forename: Juan de D
authors.initials: Jde D
authors.lastname: García-Díaz
authors.forename: Jorge
authors.initials: J
authors.lastname: Gómez-Cerezo
authors.forename: Javier
authors.initials: J
authors.lastname: Mateos
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: del Valle
authors.forename: Jesús
authors.initials: J
authors.lastname: Medina-Asensio
authors.forename: Luis F
authors.initials: LF
authors.lastname: Viejo
authors.forename: Angel
authors.initials: A
authors.lastname: Fernández-Ballesteros
authors.forename: Javier
authors.initials: J
authors.lastname: Solís
authors.forename: Almudena
authors.initials: A
authors.lastname: Herrero Domingo
authors.forename: Eva
authors.initials: E
authors.lastname: Ferreira
authors.forename: Demetrio
authors.initials: D
authors.lastname: Sánchez-Fuentes
authors.forename: José M
authors.initials: JM
authors.lastname: Barragán
authors.forename: Julio
authors.initials: J
authors.lastname: González-Moraleja
authors.forename: Juan A
authors.initials: JA
authors.lastname: Vargas
authors.forename: Manuel
authors.initials: M
authors.lastname: López-Jiménez
authors.forename: Javier
authors.initials: J
authors.lastname: Zamora
mesh_terms: 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