title: A low ankle brachial index is associated with an increased risk of cardiovascular disease: the Hisayama study.
abstract: OBJECTIVE
  Peripheral artery disease (PAD), defined as a decreased ankle brachial index (ABI), is a risk factor for cardiovascular disease; however, few studies have assessed the relationship between a low ABI and cardiovascular risks in Asian populations. We herein examined the relationship between the ABI and the development of cardiovascular disease in a Japanese community.
  
  
  METHODS
  A total of 2,954community-dwelling Japanese individuals without prior cardiovascular disease ≥ 40years of age were followed up for an average of 7.1years. The subjects' ABIs were categorized into the three groups: low (≤0.90), borderline (0.91-0.99) and normal (1.00-1.40). We estimated the relationship between the ABI and cardiovascular risk using a Cox proportional hazards model.
  
  
  RESULTS
  During the follow-up period, 134subjects experienced cardiovascular events. The incidence of cardiovascular disease across the ABI values was significantly different (p＜0.001). After adjusting for confounding factors, namely age, sex, systolic blood pressure, use of anti-hypertensive drugs, diabetes, total cholesterol, high-density lipoprotein cholesterol, obesity, smoking, alcohol intake and regular exercise, individuals with a low ABI were at 2.40-fold (95% confidence interval [CI] 1.14-5.06) greater risk of cardiovascular disease and 4.13-fold (95% CI 1.62-10.55) greater risk of coronary heart disease.
  
  
  CONCLUSIONS
  Our findings suggest that individuals with an ABI of ≤ 0.90 have an increased risk of cardiovascular events, independent from traditional risk factors, in the general Japanese population.
authors.affiliation: Department of Environmental Medicine, Graduate School of Medical Sciences, Kyushu University.
authors.forename: Iwao
authors.initials: I
authors.lastname: Kojima
authors.forename: Toshiharu
authors.initials: T
authors.lastname: Ninomiya
authors.forename: Jun
authors.initials: J
authors.lastname: Hata
authors.forename: Masayo
authors.initials: M
authors.lastname: Fukuhara
authors.forename: Yoichiro
authors.initials: Y
authors.lastname: Hirakawa
authors.forename: Naoko
authors.initials: N
authors.lastname: Mukai
authors.forename: Daigo
authors.initials: D
authors.lastname: Yoshida
authors.forename: Takanari
authors.initials: T
authors.lastname: Kitazono
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Kiyohara
mesh_terms: D055109:Ankle Brachial Index; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate