ORIGINAL CONTRIBUTIONS |
Ankle-Brachial Index and Subclinical Cardiac and Carotid Disease
The Multi-Ethnic Study of Atherosclerosis
1 Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
2 Department of Family and Preventive Medicine, University of California at San Diego, La Jolla, CA
3 Department of Public Health Sciences, School of Medicine, Wake Forest University, Winston-Salem, NC
4 Department of Medicine, School of Medicine, University of California at Los Angeles, Los Angeles, CA
5 Epidemiology and Biometry Program, Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, Bethesda, MD
6 Department of Medicine, School of Medicine and Public Health, Columbia University, New York, NY
7 Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
Correspondence to Dr. Mary McGrae McDermott, Feinberg School of Medicine, Northwestern University, 675 North St. Clair Street, Suite 18-200, Chicago, IL 60611 (e-mail: mdm608{at}northwestern.edu).
The authors studied associations between ankle-brachial index (ABI) and subclinical atherosclerosis in the Multi-Ethnic Study of Atherosclerosis. Participants included 3,458 women (average age = 62.6 years) and 3,112 men (average age = 62.8 years) who were free of clinically evident cardiovascular disease. Measurements included ABI, carotid artery intima-media thickness, and coronary artery calcium assessed with computed tomography. Five ABI categories were defined: <0.90 (definite peripheral arterial disease (PAD)), 0.90–0.99 (borderline ABI), 1.00–1.09 (low-normal ABI), 1.10–1.29 (normal ABI), and 
1.30 (high ABI). Compared with that in men with normal ABI, significantly higher internal carotid artery intima-media thickness was observed in men with definite PAD (1.58 vs. 1.09; p < 0.001), borderline ABI (1.33 vs. 1.09; p < 0.001), and low-normal ABI (1.18 vs. 1.09; p < 0.001) after adjustment for confounders. Fully adjusted odds ratios for a coronary artery calcium score greater than 20 decreased across progressively higher ABI categories in both women (2.85 (definite PAD), 1.27 (borderline ABI), 1.11 (low-normal ABI), 1.00 (normal ABI; referent), and 0.78 (high ABI); p for trend = 0.0002) and men (3.26 (definite PAD), 1.72 (borderline ABI), 1.14 (low-normal ABI), 1.00 (normal ABI; referent), and 1.43 (high ABI); p for trend = 0.0002). These findings indicate excess coronary and carotid atherosclerosis at ABI values below 1.10 (men) and 1.00 (women) and may imply increased risk of cardiovascular events in persons with borderline and low-normal ABI.
arterial occlusive diseases; arteriosclerosis; carotid artery diseases; coronary disease; heart diseases
Abbreviations: ABI, ankle-brachial index; CAC, coronary artery calcium; IMT, intima-media thickness; IQR, interquartile range; MESA, Multi-Ethnic Study of Atherosclerosis; PAD, peripheral arterial disease
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