title: A high ankle-brachial index is associated with increased aortic pulse wave velocity: the Czech post-MONICA study.
abstract: BACKGROUND
  Ankle brachial index (ABI) has been increasingly used in general practice to identify individuals with low ABI at high cardiovascular risk. However, there has been no consensus on the clinical significance of high ABI. The aim of our study was to compare aortic stiffness as a marker of cardiovascular risk in individuals with low (<1.0), normal (1.0-1.4), and high ABI (>1.4).
  
  
  METHODS
  A total of 911 individuals from the Czech post-MONICA study (a randomly selected 1% representative population sample, aged 54 ± 13.5 years, 47% of men) were examined. ABI was measured using a handheld Doppler and aortic pulse wave velocity (aPWV) using the Sphygmocor device.
  
  
  RESULTS
  Of the 911 individuals, 28 (3.1%) had low ABI and 23 (2.5%) high ABI. There was a U-shaped association between aPWV and ABI. aPWV was significantly higher in individuals with low and high ABI compared with the normal ABI group (11.1 ± 2.8, 8.3 ± 2.3, p < 0.001; 10.8 ± 2.5, 8.3 ± 2.3 m/s, p < 0.001, respectively). In a model adjusted for age, sex, systolic, diastolic, mean blood pressure and examiner, aPWV remained increased in both extreme ABI groups compared with the normal ABI group. In logistic regression analysis, aPWV together with glucose level, male sex, and a history of deep venous thrombosis were independent predictors of high ABI, while cholesterol was not.
  
  
  CONCLUSIONS
  This is the first study showing increased aortic stiffness in individuals with high ABI, presumably responsible for increased left ventricular mass described previously in this group. These findings suggest increased cardiovascular risk of high ABI individuals.
authors: Department of Preventive Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic. wohlfp@gmail.com
authors: Peter
authors: P
authors: Wohlfahrt
authors: Daniel
authors: D
authors: Palous
authors: Michaela
authors: M
authors: Ingrischová
authors: Alena
authors: A
authors: Krajcoviechová
authors: Jitka
authors: J
authors: Seidlerová
authors: Markéta
authors: M
authors: Galovcová
authors: Jan
authors: J
authors: Bruthans
authors: Marie
authors: M
authors: Jozífová
authors: Vera
authors: V
authors: Adámková
authors: Jan
authors: J
authors: Filipovsky
authors: Renata
authors: R
authors: Cífková
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D055109:Ankle Brachial Index; D001011:Aorta / Q000000981:diagnostic imaging / Q000503:physiopathology*; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D003187:Compliance; D018153:Czech Republic; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011673:Pulsatile Flow; D018570:Risk Assessment; D012307:Risk Factors; D018608:Ultrasonography, Doppler