title: Estimating the risk of peripheral artery disease using different population strategies.
abstract: OBJECTIVE
  The objective of this study is to compare the clinical performance of different strategies, REASON, PREVALENT, Inter-Society Consensus (ISC), and the American College of Cardiology/American Heart Association (ACC/AHA) Guidelines, in the selection of candidates for peripheral artery disease (PAD) screening using ankle-brachial index (ABI).
  
  
  METHODS
  Our work is a population-based cross-sectional study conducted in Extremadura (Spain) in 2007-2009. Participants were ≥50years old and free of cardiovascular disease. ABI and cardiovascular risk factors were measured.
  
  
  RESULTS
  In total, 1288 individuals (53% women), with a mean age of 63years (standard deviation (SD) 9) were included. The prevalence of ABI <0.9 was 4.9%. REASON risk score identified 53% of the sample to screen with sensitivity of 87.3%, quite similar to that identified in ISC and ACC/AHA strategies (both 90.5%), and specificity of 48.3%, higher than that of the ISC (30.9%) and ACC/AHA (31.1%) strategies. Although the Youden index was 0.4 for both REASON and PREVALENT risk scores, the latter's sensitivity was 60.3%, almost 30 points less than all other strategies.
  
  
  CONCLUSIONS
  REASON risk score was the strategy with the highest clinical performance and efficiency, with sensitivity of 87.3% and specificity higher than that of the ISC and ACC/AHA strategies. Although very specific, the PREVALENT strategy had low sensitivity making it difficult to be implemented as a screening tool.
authors.affiliation: Cardiovascular Epidemiology and Genetics, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain. Electronic address: mgrau@imim.es.
authors.forename: Maria
authors.initials: M
authors.lastname: Grau
authors.forename: Jose-Miguel
authors.initials: JM
authors.lastname: Baena-Díez
authors.forename: Francisco-Javier
authors.initials: FJ
authors.lastname: Félix-Redondo
authors.forename: Daniel
authors.initials: D
authors.lastname: Fernández-Berges
authors.forename: Marc
authors.initials: M
authors.lastname: Comas-Cufí
authors.forename: Rosa
authors.initials: R
authors.lastname: Forés
authors.forename: Jaume
authors.initials: J
authors.lastname: Marrugat
authors.forename: Rafel
authors.initials: R
authors.lastname: Ramos
mesh_terms: D000368:Aged; D055109:Ankle Brachial Index; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013030:Spain / Q000453:epidemiology
keywords: Ankle-brachial index; Atherosclerosis; Peripheral artery disease; Primary prevention; Risk factors; Screening