The Ankle-Brachial Blood Pressure Index as a Risk Indicator of Generalized Atherosclerosis

ABSTRACT

Contemporary methods of assessment of possible cardiovascular disease based on traditional risk factors are not perfect. Therefore new ways are sought. Simple and inexpensive methods include assessment of the blood pressure on the lower extremities above the ankles. The finding of a reduced ratio of the ankle-brachial blood pressure index (ABI) indicates atherosclerosis of the lower extremity arteries. ABI values of 0.9 or less are associated with a significantly increased risk of cardiovascular diseases (in particular myocardial infarction and stroke) that is independent of other risk factors. ABI assessment is a simple clinical examination and should be performed in middle-aged and elderly subjects with a medium and high cardiovascular risk in order to define more accurately their health status. Patients with reduced ABI of 0.9 or less are candidates for secondary preventive treatment for cardiovascular disease.

KEYWORD

Atherosclerosis - risk factors - ankle brachial index

REFERENCES

• 1 Wood D, Faergeman O, Pyörälä K. Prevention of coronary heart disease in clinical practice. Recommendations of the Second Joint Task Force of European and Other Societies on Coronary Prevention.  Eur Heart J . 1998;  19 1434-1503
• 2 Sorrentino M J. Cholesterol reduction to prevent CAD. What do the data show?.  Postgrad Med . 2000;  108 45-52
• 3 Neaton J D, Wentworth D. Serum cholesterol, blood pressure, cigarette smoking, and death from coronary heart disease.  Arch Intern Med . 1992;  1 56-64
• 4 Dagenais G R, Robitaille N M, Lupien P J. First coronary heart disease event rates in relation to major risk factors: Quebec Cardiovascular Study.  Can J Cardiol . 1990;  7 274-280
• 5 Ridker P M. High-sensitivity C-reactive protein.  Circulation . 2001;  13 1813-1818
• 6 Kannel W. On checking the pulse.  Eur Heart J . 2000;  21 97-98
• 7 Zakopoulos N A, Lekakis J P, Papamichael C M. Pulse pressure in normotensives: a marker of cardiovascular disease.  Am J Hypert . 2001;  3 195-199
• 8 Greenland P, Abrams J, Aurigemma G P. Prevention Conference V. Beyond secondary prevention: identifying the high-risk patients for primary prevention. Noninvasive test of atherosclerotic burden.  Circulation . 2000;  101 E16-22
• 9 TASC Working Group. Management of peripheral arterial disease.  Intern Angiol . 2000;  19(Suppl) 1-260
• 10 Pearson T A. New tools for coronary risk assessment. What are their advantage and limitations?.  Circulation . 2002;  105 886-892
• 11 Clement D L, Boccalon H, Dormandy J. A clinical approach to the management of the patients with coronary and/or carotid artery disease who present with leg ischemia (CoCaLis document).  Inter Angiol . 2000;  19 97-125
• 12 Criqui M H, Langer R D, Frone;abk A. Mortality over a period of 10 years in patients with peripheral arterial disease.  N Engl J Med . 1992;  326 381-386
• 13 McKenna M, Wolfson S, Kuller L. The ratio of ankle and arm arterial pressure as an independent predictor of mortality.  Atherosclerosis . 1991;  87 119-128
• 14 Newmann A B, Siscovick D S, Manolio T A. Ankle-arm index as a marker of atherosclerosis in the Cardiovascular Health Study.  Circulation . 1993;  88 837-845
• 15 Newmann A B, Shemanski L, Manolio T A. Ankle-arm index as a predictor of cardiovascular disease and mortality in the Cardiovascular Health Study.  Arteriosler Thromb Vasc Biol . 1999;  19 535-545
• 16 Zheng Z I, Sharrett A R, Chambless L E. Association of ankle-brachial index with clinical coronary heart disease, stroke and preclinical carotid and popliteal atherosclerosis: the Atherosclerosis Risk in Communities (ARIC) Study.  Atherosclerosis . 1997;  131 115-125
• 17 Tsai A N, Folsom A R, Rosamond W D, Jones D W. Ankle-brachial index and 7-year ischemic stroke incidence. The ARIC study.  Stroke . 2001;  32 1721-1724
• 18 Kornitzer M, Dramaix M, Sobolski J. Ankle/arm pressure index in asymptomatic middle-aged males: an independent predictor of ten-year coronary heart disease mortality.  Angiology . 1995;  46 211-219
• 19 Leng G C, Fowkes F C, Lee A J. Use of ankle-brachial pressure index to predict cardiovascular events and death: a cohort study.  Brit Med J . 1996;  313 1440-1444
• 20 Jager A, Kostense P J, Ruhe H G. Microalbuminuria and peripheral arterial disease are independent predictors of cardiovascular and all-cause mortality, especially among hypertensive subjects: five-year follow-up of the Hoorn study.  Arterioscl Thromb Vasc Biol . 1999;  19 617-624
• 21 Ogren M, Hedblad B, Isacsson S O. Ten-year cerebrovascular morbidity and mortality in 68-year old men with asymptomatic carotid stenosis.  Brit Med J . 1995;  310 1294-1298