The association of the ankle-brachial index with incident coronary heart disease: the Atherosclerosis Risk In Communities (ARIC) study, 1987-2001

Public Deposited
Analytics

Downloadable Content

Download PDF
Request Version for Screen Reader
Creator
  • Weatherley, Beth D
    • Other Affiliation: Duke Clinical Research Institute, Duke University Medical Center, P.O. Box 17969, Durham, NC 27715, USA
  • Nelson, Jeanenne J
    • Other Affiliation: Worldwide Epidemiology, MAI-C.2314.2C, GlaxoSmithKline, Five Moore Drive, PO Box 13398, Durham, NC, USA
  • Heiss, Gerardo
    • Affiliation: Gillings School of Global Public Health, Department of Epidemiology
  • Chambless, Lloyd E
    • Affiliation: Gillings School of Global Public Health, Department of Biostatistics
  • Sharrett, A Richey
    • Other Affiliation: Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
  • Nieto, F Javier
    • Other Affiliation: Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health,610 Walnut Street, 707C WARF, Madison, WI 53726, USA
  • Folsom, Aaron R
    • Other Affiliation: Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
  • Rosamond, Wayne D.
    • Affiliation: Gillings School of Global Public Health, Department of Epidemiology
Abstract
  • Abstract Background Peripheral arterial disease (PAD), defined by a low ankle-brachial index (ABI), is associated with an increased risk of cardiovascular events, but the risk of coronary heart disease (CHD) over the range of the ABI is not well characterized, nor described for African Americans. Methods The ABI was measured in 12186 white and African American men and women in the Atherosclerosis Risk in Communities Study in 1987–89. Fatal and non-fatal CHD events were ascertained through annual telephone contacts, surveys of hospital discharge lists and death certificate data, and clinical examinations, including electrocardiograms, every 3 years. Participants were followed for a median of 13.1 years. Age- and field-center-adjusted hazard ratios (HRs) were estimated using Cox regression models. Results Over a median 13.1 years follow-up, 964 fatal or non-fatal CHD events accrued. In whites, the age- and field-center-adjusted CHD hazard ratio (HR, 95% CI) for PAD (ABI<0.90) was 2.81 (1.77–4.45) for men and 2.05 (1.20–3.53) for women. In African Americans, the HR for men was 4.86 (2.76–8.47) and for women was 2.34 (1.26–4.35). The CHD risk increased exponentially with decreasing ABI as a continuous function, and continued to decline at ABI values > 1.0, in all race-gender subgroups. The association between the ABI and CHD relative risk was similar for men and women in both race groups. A 0.10 lower ABI increased the CHD hazard by 25% (95% CI 17–34%) in white men, by 20% (8–33%) in white women, by 34% (19–50%) in African American men, and by 32% (17–50%) in African American women. Conclusion African American members of the ARIC cohort had higher prevalences of PAD and greater risk of CHD associated with ABI-defined PAD than did white participants. Unlike in other cohorts, in ARIC the CHD risk failed to increase at high (>1.3) ABI values. We conclude that at this time high ABI values should not be routinely considered a marker for increased CVD risk in the general population. Further research is needed on the value of the ABI at specific cutpoints for risk stratification in the context of traditional risk factors.
Date of publication
DOI
Identifier
Resource type
  • Article
Rights statement
  • In Copyright
Rights holder
  • Beth D Weatherley et al.; licensee BioMed Central Ltd.
License
Journal title
  • BMC Cardiovascular Disorders
Journal volume
  • 7
Journal issue
  • 1
Page start
  • 3
Language
  • English
Is the article or chapter peer-reviewed?
  • Yes
ISSN
  • 1471-2261
Bibliographic citation
  • BMC Cardiovascular Disorders. 2007 Jan 16;7(1):3
Publisher
  • BioMed Central Ltd
Access right
  • Open Access
Date uploaded
  • September 5, 2012

Relations

Parents:

This work has no parents.

Items

Thumbnail Title Date Uploaded Visibility Actions
file details 1471-2261-7-3.pdf 2019-05-07 Public Download
file details 1471-2261-7-3.xml 2019-05-07 Public Download