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CARDIOVASCULAR RISK

A High Ankle Brachial Index Is Associated With Greater Left Ventricular Mass

MESA (Multi-Ethnic Study of Atherosclerosis)

Joachim H. Ix, MD, MAS^_*,,,_*, Ronit Katz, DPhil, Carmen A. Peralta, MD, MAS^#,_**, Ian H. de Boer, MD, MS^||, Matthew A. Allison, MD, MPH, David A. Bluemke, MD, PhD, David S. Siscovick, MD, MPH^¶, João A.C. Lima, MD and Michael H. Criqui, MD, MPH

^_* Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, San Diego, California
Division of Preventive Medicine, Department of Family and Preventive Medicine, University of California San Diego, San Diego, California
Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, California
Collaborative Health Studies Coordinating Center, Department of Biostatistics, University of Washington, Seattle, Washington
^|| Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington
^¶ Cardiovascular Health Research Unit, Departments of Medicine and Epidemiology, University of Washington, Seattle, Washington
^# Division of Nephrology, Department of Medicine, University of California San Francisco, San Francisco, California
^_** San Francisco Veterans Affairs Medical Center, San Francisco, California
Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Maryland
Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland

Manuscript received June 25, 2009; revised manuscript received November 9, 2009, accepted November 10, 2009.

^_* Reprint requests and correspondence: Dr. Joachim H. Ix, Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, San Diego VA Healthcare System, 3350 La Jolla Village Drive, Mail Code 111-H, San Diego, California 92161 (Email: joeix{at}ucsd.edu).

Objectives: This study sought to determine the association of high ankle brachial index (ABI) measurements with left ventricular (LV) mass, and to compare its strength with that of low ABI with LV mass.

Background: Arterial stiffness leads to LV mass through nonatherosclerotic pathways in mice. In humans, a high ABI indicates stiff peripheral arteries and is associated with cardiovascular disease (CVD) events. Whether high ABI is associated with LV mass in humans and whether this might reflect consequences of arterial stiffness, atherosclerosis, or both is unknown.

Methods: Among 4,972 MESA (Multi-Ethnic Study of Atherosclerosis) participants without clinical CVD, we used linear regression to evaluate the association of low (<0.90) and high (>1.40 or incompressible) ABI with LV mass by cardiac magnetic resonance imaging (MRI). Intermediate ABIs served as the reference category. To determine the effect of subclinical atherosclerosis, models were adjusted for common and internal carotid intima media thickness (cIMT) and natural log-transformed coronary artery calcification.

Results: Compared with subjects with intermediate ABI, LV mass was higher with either low (2.70 g/m² higher, 95% confidence interval: 0.65 to 4.75) or high ABI (6.84 g/m² higher, 95% confidence interval: 3.2 to 10.47) after adjustment for traditional CVD risk factors, kidney function, and C-reactive protein. However, further adjustment for cIMT and CAC substantially attenuated the association of low ABI with LV mass index (1.24 g/m² higher, 95% confidence interval: –0.84 to 3.33), whereas the association of high ABI was minimally altered (6.01 g/m² higher, 95% confidence interval: 2.36 to 9.67).

Conclusions: High ABI is associated with greater LV mass; an association that is not attenuated with adjustment for subclinical atherosclerosis in nonperipheral arterial beds. High ABI might lead to greater LV mass through nonatherosclerotic pathways.

Key Words: cardiovascular disease • heart failure • left ventricular mass • medial arterial calcification • vascular stiffness

Abbreviations and Acronyms   ABI = ankle brachial index   CAC = coronary artery calcification   CHF = congestive heart failure   cIMT = carotid intima media thickness   CRP = C-reactive protein   CVD = cardiovascular disease   LV = left ventricular   LVEDV = left ventricular end-diastolic volume   LVEF = left ventricular ejection fraction   LVESV = left ventricular end-systolic volume   MAC = medial arterial calcification   MRI = magnetic resonance imaging   PAD = peripheral arterial disease   SBP = systolic blood pressure

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