CLINICAL RESEARCH: PERIPHERAL VASCULAR DISEASE
A High Ankle-Brachial Index Is Associated With Increased Cardiovascular Disease Morbidity and Lower Quality of Life
Matthew A. Allison, MD, MPH*,*,
William R. Hiatt, MD ,
Alan T. Hirsch, MD||,¶,
Joseph R. Coll, PhD and
Michael H. Criqui, MD, MPH*,
* Department of Family and Preventive Medicine, University of California San Diego, San Diego, California
Department of Medicine, University of California San Diego, San Diego, California
Department of Medicine, University of Colorado School of Medicine and the Colorado Prevention Center, Denver, Colorado
Department of Preventive Medicine and Biostatistics, University of Colorado School of Medicine and the Colorado Prevention Center, Denver, Colorado
|| Vascular Medicine Program, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
¶ Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota.
Manuscript received May 21, 2007;
revised manuscript received November 19, 2007,
accepted November 27, 2007.
* Reprint requests and correspondence: Dr. Matthew A. Allison, 3855 Health Sciences Drive, MC 0817, La Jolla, California 92093-0817. (Email: mallison{at}ucsd.edu).
Objectives: The purpose of this study is to determine if an ankle-brachial index (ABI)  1.40 is associated with reduced quality of life (QoL).
Background: Ankle-brachial index values 1.40 have been associated with some cardiovascular disease (CVD) risk factors and increased mortality, but the relationship to other disease morbidity such as reduced QoL has not been previously evaluated.
Methods: The PARTNERS (PAD Awareness, Risk and Treatment: New Resources for Survival) program was a national cross-sectional study of 7,155 patients age >50 years recruited from 350 primary care sites. All sites performed the ABI using a Doppler device and a standardized technique.
Results: A total of 296 subjects had an ABI 1.40 in at least 1 leg, and 4,420 had an ABI between 0.90 and 1.40. Diabetes, male gender, and waist circumference were positively associated with a high ABI, and smoking and dyslipidemia were inversely associated with a high ABI. After adjustment for age, gender, and the traditional CVD risk factors, and accounting for multiple comparisons, the high ABI group had significantly higher odds for foot ulcers (p < 0.005) and borderline associations with heart failure, stroke, and neuropathy. After the same adjustments and adjusting for patients with other CVD, the high ABI group scored 2.0 points lower on the physical component scale on the Medical Outcomes Study Standard Form–36 and 5.5 points lower on the Walking Impairment Questionnaire walking distance domain (p < 0.05 for both).
Conclusion: Individuals with a high ABI have higher odds for foot ulcers and neuropathy, as well as lower scores on some physical functioning QoL domains.
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Abbreviations and Acronyms
| | ABI = ankle-brachial index | | BMI = body mass index | | CHF = congestive heart failure | | CVD = cardiovascular disease | | HDL = high-density lipoprotein | | OR = odds ratio | | PAD = peripheral arterial disease | | QoL = quality of life | | SF-36 = Medical Outcomes Study Standard Form-36 | | WIQ = Walking Impairment Questionnaire |
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