title: Associations of borderline and low normal ankle-brachial index values with functional decline at 5-year follow-up: the WALCS (Walking and Leg Circulation Study).
abstract: OBJECTIVE
  We studied associations of borderline and low normal ankle-brachial index (ABI) values with functional decline over a 5-year follow-up.
  
  
  BACKGROUND
  The associations of borderline and low normal ABI with functional decline are unknown.
  
  
  METHODS
  The 666 participants included 412 with peripheral arterial disease (PAD). Participants were categorized as follows: severe PAD (ABI <0.50), moderate PAD (ABI 0.50 to 0.69), mild PAD (ABI 0.70 to 0.89), borderline ABI (0.90 to 0.99), low normal ABI (1.00 to 1.09), and normal ABI (ABI 1.10 to 1.30). Outcomes were assessed annually for 5 years. Mobility loss was defined as loss of the ability to walk one-quarter mile or walk up and down 1 flight of stairs without assistance among participants without baseline mobility impairment. Becoming unable to walk for 6 min continuously was defined as stopping during the 6-min walk at follow-up among those who walked for 6 min continuously at baseline. Results were adjusted for age, sex, race, comorbidities, and other confounders.
  
  
  RESULTS
  Hazard ratios (HRs) for mobility loss according to ABI category were as follows: severe PAD, HR: 4.16 (95% confidence interval [CI]: 1.58 to 10.92); moderate PAD, HR: 3.82 (95% CI: 1.66 to 8.81); mild PAD, HR: 3.22 (95% CI: 1.43 to 7.21); borderline ABI, HR: 3.07 (95% CI: 1.21 to 7.84); and low normal ABI, HR: 2.61 (95% CI: 1.08 to 6.32; p trend = 0.0018). Similar associations were observed for becoming unable to walk for 6 min continuously (p trend < 0.0001).
  
  
  CONCLUSIONS
  At 5-year follow-up, persons with borderline ABI values have a higher incidence of mobility loss and becoming unable to walk for 6 min continuously compared with persons who have a normal baseline ABI. A low normal ABI is associated with an increased incidence of mobility loss compared with persons who have a normal ABI.
authors.affiliation: Department of Medicine, Northwestern University's Feinberg School of Medicine, 750 North Lake Shore Drive, Chicago, IL 60611, USA. mdm608@northwestern.edu
authors.forename: Mary M
authors.initials: MM
authors.lastname: McDermott
authors.forename: Jack M
authors.initials: JM
authors.lastname: Guralnik
authors.forename: Lu
authors.initials: L
authors.lastname: Tian
authors.forename: Kiang
authors.initials: K
authors.lastname: Liu
authors.forename: Luigi
authors.initials: L
authors.lastname: Ferrucci
authors.forename: Yihua
authors.initials: Y
authors.lastname: Liao
authors.forename: Leena
authors.initials: L
authors.lastname: Sharma
authors.forename: Michael H
authors.initials: MH
authors.lastname: Criqui
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D055109:Ankle Brachial Index; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007866:Leg / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D016491:Peripheral Vascular Diseases / Q000503:physiopathology*; D011446:Prospective Studies; D012039:Regional Blood Flow; D016138:Walking / Q000502:physiology*