title: Incident physical disability in people with lower extremity peripheral arterial disease: the role of cardiovascular disease.
abstract: OBJECTIVE
  To evaluate the risk of incident physical disability and the decline in gait speed over a 6-year follow-up associated with a low ankle-arm index (AAI) in older adults.
  
  
  METHODS
  Observational cohort study.
  
  
  METHODS
  Forsyth County, North Carolina; Sacramento County, California; Washington County, Maryland; and Allegheny County, Pennsylvania.
  
  
  METHODS
  Four thousand seven hundred five older adults, 58% women and 17.6% black, participating in the Cardiovascular Health Study.
  
  
  METHODS
  AAI was measured in 1992/93 (baseline). Self-reported mobility, activity of daily living (ADL), and instrumental activity of daily living (IADL) disability and gait speed were recorded at baseline and at 1-year intervals over 6 years of follow-up. Mobility disability was defined as any difficulty walking half a mile and ADL and IADL disability was defined as any difficulty with 11 specific ADL and IADL tasks. Individuals with mobility, ADL, or IADL disability at baseline were excluded from the respective incident disability analyses.
  
  
  RESULTS
  Lower baseline AAI values were associated with increased risk of mobility disability and ADL/IADL disability. Clinical cardiovascular disease (CVD), diabetes mellitus, and interim CVD events partially explained these associations for mobility disability and clinical CVD and diabetes mellitus partially explained these associations for ADL and IADL disability. Individuals with an AAI less than 0.9 had on average a mean decrease in gait speed of 0.02 m/s per year, or a decline of 0.12 m/s over the 6-year follow-up. Prevalent CVD partly explained this decrease but interim CVD events did not further attenuate it.
  
  
  CONCLUSIONS
  Low AAI serves as marker of future disability risk. Reduction of disability risk in patients with a low AAI should consider cardiovascular comorbidity and the prevention of additional disabling CVD events.
authors.affiliation: Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA 15260, USA. jbrach@pitt.edu
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Brach
authors.forename: Cam
authors.initials: C
authors.lastname: Solomon
authors.forename: Barbara L
authors.initials: BL
authors.lastname: Naydeck
authors.forename: Kim
authors.initials: K
authors.lastname: Sutton-Tyrrell
authors.forename: Paul L
authors.initials: PL
authors.lastname: Enright
authors.forename: Nancy Swords
authors.initials: NS
authors.lastname: Jenny
authors.forename: Paulo M
authors.initials: PM
authors.lastname: Chaves
authors.forename: Anne B
authors.initials: AB
authors.lastname: Newman
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D015331:Cohort Studies; D015897:Comorbidity; D004185:Disability Evaluation; D005260:Female; D005684:Gait; D015577:Geriatric Assessment; D006801:Humans; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D051346:Mobility Limitation; D016491:Peripheral Vascular Diseases / Q000453:epidemiology* / Q000503:physiopathology*; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D014481:United States / Q000453:epidemiology