[Value of the ankle-brachial index in cardiovascular risk stratification of patients without known atherotrombotic disease. MERITO study].
OBJECTIVE
Peripheral arterial disease detected by measurement of ankle-brachial index enables the identification of asymptomatic patients with target organ damage. We have investigated the prevalence of peripheral arterial disease (ankle-brachial index < 0.9), and its potential clinical-therapeutic impact, in patients without known atherotrombotic disease from internal medicine practices.


METHODS
It was a multicenter, cross-sectional, observational study. Outpatients aged 50 through 80 years, with either diabetes or a SCORE risk estimation of at least 3%, were enrolled.


RESULTS
A total of 1,519 subjects (58% men) were evaluated, 917 with diabetes (61%). The mean age (standard deviation) was 66.2 (8.3) years. The prevalence of an ankle-brachial index < 0.9 was 26.19%. In multiple logistic regressions the risk factors associated to an ankle-brachial index < 0.9 were age, sedentary lifestyle, smoking, macroalbuminuria, and heart rate. There was a significant relationship between the ankle-brachial index and the SCORE risk estimation. With respect to the therapeutic aims of the patients with an ankle-brachial index < 0.9, only 21% were taking antiplatelet drugs, 26% showed low density lipoproteins-cholesterol values < 100 mg/dl (53% < 130 mg/dl), and 16% displayed recommended blood pressure levels.


CONCLUSIONS
Measurement of ankle-brachial is useful to reclassify as high risk a significant proportion of patients without known previous atherotrombotic disease. The ankle-brachial index should be incorporated into routine cardiovascular evaluation, particularly in subjects with diabetes or a score risk assessment > or = 3%.
Manzano
Luis
L
Unidad de Insuficiencia Cardíaca y Riesgo Vascular del Anciano, Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, España. luis.manzano@uah.es
Mostaza
José María
JM
Suárez
Carmen
C
Cairols
Marc
M
Redondo
Rubén
R
Valdivielso
Pedro
P
Monte
Rafael
R
Blázquez
Julio César
JC
Ferreira
Eva María
EM
Trouillhet
Isabel
I
González-Igual
Jesús J
JJ
Sánchez-Zamorano
Miguel A
MA
D000368:Aged; D000369:Aged, 80 and over; D000419:Albuminuria / Q000150:complications; D000842:Ankle; D002318:Cardiovascular Diseases / Q000209:etiology*; D003430:Cross-Sectional Studies; D048909:Diabetes Complications; D050171:Dyslipidemias / Q000150:complications; D005260:Female; D006339:Heart Rate; D006801:Humans; D006973:Hypertension / Q000150:complications; D008019:Life Style; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D011795:Surveys and Questionnaires