In recent years, we have come a long way from categorizing all ankle-brachial indices (ABIs) above 0.90 as normal. Both borderline low and high ABIs present significant risk (1). In this issue of the Journal, Arain et al. (2) at the Mayo Clinic document the risk of a high ABI with the largest such study to date. The authors provide us with remarkable data, presented clearly and concisely, on patients with “poorly compressible arteries” (PCA). The more common term for PCA is “high ABI,” since the ratio of the pressure at the ankle to the arm is falsely elevated by selective stiffening of the ankle, but not the brachial, arteries by medial arterial calcinosis (MAC). Such falsely elevated ABI levels may occur at ABI levels of 1.30, although 1.40, the cut point used by the authors, is a more specific and conventional cut point for high ABI. Such high ABIs are infrequent in population studies, with prevalence estimates of 1.4% (3) to 2.8% (1). However, they are much more common in older patients, and those with diabetes or chronic kidney disease (CKD), all groups at elevated risk of cardiovascular disease (CVD) events. It is important to note that in MAC, the calcification is in the arterial media, as opposed to the intima, which is the typical location of atherosclerotic calcification in the arteries (4). A number of population-based cohort studies, carefully reviewed by Arain et al. (2), have shown an increased risk of CVD events and total mortality for those with high as well as low ABIs. Typically, the risk in population studies for a high ABI is about the same as for moderate peripheral artery disease (PAD), with severe PAD showing a much higher risk (1).