Aboyans V, Ho E, Denenberg JO, Ho LA, Natarajan L, Criqui MH, et al.
Journal of vascular surgery. Date of publication 2008 Nov 1;volume 48(5):1197-203.
1. J Vasc Surg. 2008 Nov;48(5):1197-203. doi: 10.1016/j.jvs.2008.06.005. Epub 2008
Aug 9.
The association between elevated ankle systolic pressures and peripheral
occlusive arterial disease in diabetic and nondiabetic subjects.
Aboyans V(1), Ho E, Denenberg JO, Ho LA, Natarajan L, Criqui MH.
Author information:
(1)Department of Family and Preventive Medicine, University of California, San
Diego, La Jolla, CA, USA. aboyans@unilim.fr
OBJECTIVE: The presence of a high ankle-brachial index (ABI) is related to stiff
ankle arteries due to medial calcification. Recently, this condition has
attracted new interest after reports of a worse cardiovascular prognosis, similar
to a low ABI. We sought to compare risk factors contributing to a low (< or
=0.90) and high (> or =1.40) ABI. Additionally, we hypothesized that in instances
of high ABI, occlusive PAD may coexist.
METHOD: This cross-sectional study was conducted at vascular laboratories in a
university medical center. The subjects were 510 ambulatory patients (37% had
diabetes) previously examined at our vascular laboratories and who responded
positively to our invitation. We collected data on smoking, diabetes,
hypertension, dyslipidemia, and cardiovascular disease history. The noninvasive
assessment of lower limb arteries consisted of the measurement of ABI,
toe-brachial index (TBI), and posterior tibial artery peak flow velocity (Pk-PT).
A TBI >0.7 and a Pk-PT >10 cm/s were considered normal.
RESULTS: High- and low-ABI were detected, respectively, in 2.1% and 57.8% of
limbs. For a low ABI, age (odds ratio [OR], 1.29/10 y), pack-years (OR, 1.08/10
units), and hypertension (OR, 1.90) were independent significant (P < .001)
factors. A strong association was found between diabetes and high ABI (OR, 16.0;
P < .001). When ABI ranges were compared with TBI and Pk-PT results, those with
ABI < or =0.90 and ABI > or =1.40 presented similar patterns of abnormalities.
Pk-PT or TBI, or both, was abnormal in more than 80% of cases in both ABI < or
=0.90 and > or =1.40 groups. The ABI vs TBI relationship appeared linear in
nondiabetic patients, but had an inverted J-shape in diabetic patients,
suggesting high ABI masked leg ischemia.
CONCLUSIONS: Diabetes is the dominant risk factor for a high (> or =1.40) ABI.
Occlusive PAD is highly prevalent in subjects with high ABI, and these subjects
should be considered as PAD-equivalent.
DOI: 10.1016/j.jvs.2008.06.005
PMID: 18692981 [Indexed for MEDLINE]
