Associations of ankle-brachial index with clinical coronary heart disease, stroke and preclinical carotid and popliteal atherosclerosis

The Atherosclerosis Risk in Communities (ARIC) study

Zhi Jie Zheng, A. Richey Sharrett, Lloyd E. Chambless, Wayne D. Rosamond, F. Javier Nieto, David S. Sheps, Adrian S Dobs, Gregory W. Evans, Gerardo Heiss

Research output: Contribution to journalArticle

Abstract

The resting ankle-brachial index (ABI) is a non-invasive method to assess the patency of the lower extremity arterial system and to screen for the presence of peripheral occlusive arterial disease. To determine how the ABI is associated with clinical coronary heart disease (CHD), stroke, preclinical carotid plaque and far wall intimal-medial thickness (IMT) of the carotid and popliteal arteries, we conducted analyses in 15106 middle-aged adults from the baseline examination (1987-1989) of the Atherosclerosis Risk in Communities (ARIC) Study. The prevalence of clinical CHD, stroke/transient ischemic attack (TIA) and preclinical carotid plaque increased with decreasing ABI levels, particularly at those of <0.90. Individuals with ABI <0.90 were twice as likely to have prevalent CHD as those with ABI > 0.90 (age-adjusted odds ratio) (OR) ranging from 2.2 (95% CI: 1.0-5.1) in African- American men to 3.3 (95% CI: 2.1-5.0) in white men). Men with ABI <0.90 were more than four times as likely to have stroke/TIA as those with ABI > 0.90 (age-adjusted OR: 4.2 (95% CI: 1.8-9.5) in African-American men and 4.9 (95% CI: 2.6 -9.0) in white men). In women the association was weaker and not statistically significant. Among those free of clinical cardiovascular disease, individuals with ABI ≤ 0.90 had statistically significantly higher prevalence of preclinical carotid plaque compared to those with ABI > (0.90 (age-adjusted ORs ranging from 1.5 (95% CI: 1.0-1.9) in white women to 2.6 (95% CI: 1.06.6) in african-american men). The ABI was also inversely associated with far wall IMT of the carotid arteries (in both men and women) and the popliteal arteries (in men only). The associations of ABI with clinical CHD, stroke, preclinical carotid plaque and IMT of the carotid and popliteal arteries were attenuated and often not statistically significant after further adjustment for LDL cholesterol, cigarette smoking, hypertension and diabetes. These data demonstrate that low ABI levels, particularly those of <0.90, are indicative of generalized atherosclerosis.

Original languageEnglish (US)
Pages (from-to)115-125
Number of pages11
JournalAtherosclerosis
Volume131
Issue number1
DOIs
StatePublished - May 1997

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Ankle Brachial Index
Carotid Artery Diseases
Coronary Disease
Atherosclerosis
Stroke
Tunica Intima
Popliteal Artery
Carotid Arteries
African Americans
Peripheral Arterial Disease
Transient Ischemic Attack
LDL Cholesterol
Lower Extremity
Cardiovascular Diseases
Smoking
Odds Ratio
Hypertension

Keywords

  • Atherosclerosis
  • Carotid artery
  • Coronary heart disease
  • Peripheral arterial disease
  • Stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Associations of ankle-brachial index with clinical coronary heart disease, stroke and preclinical carotid and popliteal atherosclerosis : The Atherosclerosis Risk in Communities (ARIC) study. / Zheng, Zhi Jie; Sharrett, A. Richey; Chambless, Lloyd E.; Rosamond, Wayne D.; Nieto, F. Javier; Sheps, David S.; Dobs, Adrian S; Evans, Gregory W.; Heiss, Gerardo.

In: Atherosclerosis, Vol. 131, No. 1, 05.1997, p. 115-125.

Research output: Contribution to journalArticle

Zheng, Zhi Jie ; Sharrett, A. Richey ; Chambless, Lloyd E. ; Rosamond, Wayne D. ; Nieto, F. Javier ; Sheps, David S. ; Dobs, Adrian S ; Evans, Gregory W. ; Heiss, Gerardo. / Associations of ankle-brachial index with clinical coronary heart disease, stroke and preclinical carotid and popliteal atherosclerosis : The Atherosclerosis Risk in Communities (ARIC) study. In: Atherosclerosis. 1997 ; Vol. 131, No. 1. pp. 115-125.
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abstract = "The resting ankle-brachial index (ABI) is a non-invasive method to assess the patency of the lower extremity arterial system and to screen for the presence of peripheral occlusive arterial disease. To determine how the ABI is associated with clinical coronary heart disease (CHD), stroke, preclinical carotid plaque and far wall intimal-medial thickness (IMT) of the carotid and popliteal arteries, we conducted analyses in 15106 middle-aged adults from the baseline examination (1987-1989) of the Atherosclerosis Risk in Communities (ARIC) Study. The prevalence of clinical CHD, stroke/transient ischemic attack (TIA) and preclinical carotid plaque increased with decreasing ABI levels, particularly at those of <0.90. Individuals with ABI <0.90 were twice as likely to have prevalent CHD as those with ABI > 0.90 (age-adjusted odds ratio) (OR) ranging from 2.2 (95{\%} CI: 1.0-5.1) in African- American men to 3.3 (95{\%} CI: 2.1-5.0) in white men). Men with ABI <0.90 were more than four times as likely to have stroke/TIA as those with ABI > 0.90 (age-adjusted OR: 4.2 (95{\%} CI: 1.8-9.5) in African-American men and 4.9 (95{\%} CI: 2.6 -9.0) in white men). In women the association was weaker and not statistically significant. Among those free of clinical cardiovascular disease, individuals with ABI ≤ 0.90 had statistically significantly higher prevalence of preclinical carotid plaque compared to those with ABI > (0.90 (age-adjusted ORs ranging from 1.5 (95{\%} CI: 1.0-1.9) in white women to 2.6 (95{\%} CI: 1.06.6) in african-american men). The ABI was also inversely associated with far wall IMT of the carotid arteries (in both men and women) and the popliteal arteries (in men only). The associations of ABI with clinical CHD, stroke, preclinical carotid plaque and IMT of the carotid and popliteal arteries were attenuated and often not statistically significant after further adjustment for LDL cholesterol, cigarette smoking, hypertension and diabetes. These data demonstrate that low ABI levels, particularly those of <0.90, are indicative of generalized atherosclerosis.",
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T1 - Associations of ankle-brachial index with clinical coronary heart disease, stroke and preclinical carotid and popliteal atherosclerosis

T2 - The Atherosclerosis Risk in Communities (ARIC) study

AU - Zheng, Zhi Jie

AU - Sharrett, A. Richey

AU - Chambless, Lloyd E.

AU - Rosamond, Wayne D.

AU - Nieto, F. Javier

AU - Sheps, David S.

AU - Dobs, Adrian S

AU - Evans, Gregory W.

AU - Heiss, Gerardo

PY - 1997/5

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N2 - The resting ankle-brachial index (ABI) is a non-invasive method to assess the patency of the lower extremity arterial system and to screen for the presence of peripheral occlusive arterial disease. To determine how the ABI is associated with clinical coronary heart disease (CHD), stroke, preclinical carotid plaque and far wall intimal-medial thickness (IMT) of the carotid and popliteal arteries, we conducted analyses in 15106 middle-aged adults from the baseline examination (1987-1989) of the Atherosclerosis Risk in Communities (ARIC) Study. The prevalence of clinical CHD, stroke/transient ischemic attack (TIA) and preclinical carotid plaque increased with decreasing ABI levels, particularly at those of <0.90. Individuals with ABI <0.90 were twice as likely to have prevalent CHD as those with ABI > 0.90 (age-adjusted odds ratio) (OR) ranging from 2.2 (95% CI: 1.0-5.1) in African- American men to 3.3 (95% CI: 2.1-5.0) in white men). Men with ABI <0.90 were more than four times as likely to have stroke/TIA as those with ABI > 0.90 (age-adjusted OR: 4.2 (95% CI: 1.8-9.5) in African-American men and 4.9 (95% CI: 2.6 -9.0) in white men). In women the association was weaker and not statistically significant. Among those free of clinical cardiovascular disease, individuals with ABI ≤ 0.90 had statistically significantly higher prevalence of preclinical carotid plaque compared to those with ABI > (0.90 (age-adjusted ORs ranging from 1.5 (95% CI: 1.0-1.9) in white women to 2.6 (95% CI: 1.06.6) in african-american men). The ABI was also inversely associated with far wall IMT of the carotid arteries (in both men and women) and the popliteal arteries (in men only). The associations of ABI with clinical CHD, stroke, preclinical carotid plaque and IMT of the carotid and popliteal arteries were attenuated and often not statistically significant after further adjustment for LDL cholesterol, cigarette smoking, hypertension and diabetes. These data demonstrate that low ABI levels, particularly those of <0.90, are indicative of generalized atherosclerosis.

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