Prevalence of symptomatic and asymptomatic peripheral arterial disease and the value of the ankle-brachial index to stratify cardiovascular risk

Ramos, Rafel; Quesada, Miquel; Solanas, Pascual; Subirana Cachinero, Isaac; Sala, J.; Vila, J.; Masiá, R.; Cerezo, C.; Elosua Llanos, Roberto; Grau, M.; Cordón, Ferran; Juvinyà, Dolors; Fitó Colomer, Montserrat; Covas Planells, Maria Isabel; Clará Velasco, Alberto; Muñoz, Miguel Ángel; Marrugat de la Iglesia, Jaume; REGICOR Investigators

doi:http://dx.doi.org/10.1016/j.ejvs.2009.04.013

Prevalence of symptomatic and asymptomatic peripheral arterial disease and the value of the ankle-brachial index to stratify cardiovascular risk

Citation

Ramos R, Quesada M, Solanas P, Subirana I, Sala J, Vila J, Masiá R, Cerezo C, Elosua R, Grau M, Cordón F, Juvinyà D, Fitó M, Isabel Covas M, Clarà A, Angel Muñoz M, Marrugat J, REGICOR Investigators. Prevalence of symptomatic and asymptomatic peripheral arterial disease and the value of the ankle-brachial index to stratify cardiovascular risk. Eur J Vasc Endovasc Surg. 2009 Sep;38(3):305-11. DOI: 10.1016/j.ejvs.2009.04.013

Abstract

Objectives: To determine the prevalence of ankle-brachial index (ABI)<0.9 and symptomatic peripheral arterial disease (PAD), association with cardiovascular risk factors (CVRF), and impact of adding ABI measurement to coronary heart disease (CHD) risk screening. Design: Population-based cross-sectional survey of 6262 participants aged 35-79 in Girona, Spain. Methods: Standardized measurements (CVRF, ABI, 10-year CHD risk) and history of intermittent claudication (IC), CHD, and stroke were recorded. ABI<0.9 was considered equivalent to moderate-to-high CHD risk (> or =10%). Results: ABI<0.9 prevalence was 4.5%. Only 0.62% presented low ABI and IC. Age, current smoker, cardiovascular disease, and uncontrolled hypertension independently associated with ABI<0.9 in both sexes; IC was also associated in men and diabetes in women. Among participants 35-74 free of cardiovascular disease, 6.1% showed moderate-to-high 10-year CHD risk; adding ABI measurement yielded 8.7%. Conversely, the risk function identified 16.8% of these participants as having 10-year CHD risk>10%. In participants 75-79 free of cardiovascular disease, the prevalence of ABI<0.9 (i.e., CHD risk> or =10%) was 11.9%. Conclusions: ABI<0.9 is relatively frequent in those 35-79, particularly over 74. However, IC and CHD risk> or =10% indicators are often missing. Adding ABI measurement to CHD-risk screening better identifies moderate-to-high cardiovascular risk patients.