title: Ankle-brachial index and physical function in older individuals: The Atherosclerosis Risk in Communities (ARIC) study.
abstract: Most prior studies investigating the association of lower extremity peripheral artery disease (PAD) with physical function were small or analyzed selected populations (e.g., patients at vascular clinics or persons with reduced function), leaving particular uncertainty regarding the association in the general community.
  
  
  
  Among 5262 ARIC participants (age 71-90 years during 2011-2013), we assessed the cross-sectional association of ankle-brachial index (ABI) with the Short Physical Performance Battery (SPPB) score (0-12), its individual components (chair stands, standing balance, and gait speed) (0-4 points each), and grip strength after accounting for potential confounders, including a history of coronary disease, stroke, or heart failure.
  
  
  
  There were 411 participants (7.8%) with low ABI ≤0.90 and 469 (8.9%) participants with borderline low ABI 0.91-1.00. Both ABI ≤0.90 and 0.91-1.00 were independently associated with poor physical function (SPPB score ≤6) compared to ABI 1.11-1.20 (adjusted odds ratio 2.10 [95% CI 1.55-2.84] and 1.86 [1.38-2.51], respectively). The patterns were largely consistent across subgroups by clinical conditions (e.g., leg pain or other cardiovascular diseases), in every SPPB component, and for grip strength. ABI >1.3 (472 participants [9.0%]), indicative of non-compressible pedal arteries, was related to lower physical function as well but did not necessarily reach significance.
  
  
  
  In community-dwelling older adults, low and borderline low ABI suggestive of PAD were independently associated with poorer systemic physical function compared to those with normal ABI. Clinical attention to PAD as a potential contributor to poor physical function is warranted in community-dwelling older adults.
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. Electronic address: kmatsus5@jhmi.edu.
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Matsushita
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Shoshana H
authors.initials: SH
authors.lastname: Ballew
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Yingying
authors.initials: Y
authors.lastname: Sang
authors.affiliation: Department of Surgery, Divisions of Vascular & Cardiothoracic Surgery, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: Corey
authors.initials: C
authors.lastname: Kalbaugh
authors.affiliation: Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: Laura R
authors.initials: LR
authors.lastname: Loehr
authors.affiliation: Cardiovascular Division, University of Minnesota Physicians Heart Practice, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Alan T
authors.initials: AT
authors.lastname: Hirsch
authors.affiliation: Department of Kinesiology and Health Education, University of Texas at Austin, Austin, TX, USA.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Tanaka
authors.affiliation: Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: Gerardo
authors.initials: G
authors.lastname: Heiss
authors.affiliation: Division of Geriatrics, Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA.
authors.forename: B Gwen
authors.initials: BG
authors.lastname: Windham
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Selvin
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Josef
authors.initials: J
authors.lastname: Coresh
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D055109:Ankle Brachial Index; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D005260:Female; D005684:Gait; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D016014:Linear Models; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D058729:Peripheral Arterial Disease / Q000175:diagnosis* / Q000503:physiopathology; D004856:Postural Balance; D011237:Predictive Value of Tests; D012307:Risk Factors; D014481:United States; D016138:Walking
keywords: Aging; Peripheral artery disease; Physical function