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Molly T. Vogt, PhD; Jane A. Cauley, DrPH; Anne B. Newman, MD; Lewis H. Kuller, MD; Stephen B. Hulley, MD

JAMA. 1993;270(4):465-469.

Abstract
Objective.
—To evaluate the relationship of the ankle/arm blood pressure index to short-term mortality in women 65 years of age or older.

Design.
—Prospective cohort study with average follow-up of 4.3 years.

Setting.
—Rural community near Pittsburgh, Pa.

Participants.
—A total of 1492 white women 65 years of age or older, living in the community and ambulatory without the help of another person.

Outcome Measures.
—All-cause and cause-specific mortality.

Results.
—The ankle/arm index (the systolic pressure in the posterior tibial artery divided by that in the brachial artery) was measured in 1986 through 1988 and found to be 0.9 or less in 82 (5.5%) of the women, 67 of whom reported no symptoms of claudication. Comparing women with an index of 0.9 or less with those with an index greater than 0.9, the relative risk for all-cause mortality 4 years later (after adjustment for age, smoking, and other risk factors) was 3.1 (95% confidence interval [CI], 1.7 to 5.5); for heart disease, 3.7 (95% CI, 1.2 to 11.6); for cardiovascular diseases, 4.0 (95% CI, 1.3 to 8.5); for cancer, 3.3 (95% CI, 1.3 to 8.5); and for all other causes, 1.1 (95% CI, 0.1 to 9.2). Similar levels of risk were found after excluding women with symptoms of claudication and/or a history of cardiovascular disease at baseline.

Conclusions.
—Healthy, older women with an ankle/arm index of 0.9 or less are at high risk of death and therefore may be considered for aggressive therapy to modify cardiovascular risk factors.

(JAMA. 1993;270:465-469)

Author Affiliations
From the Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh (Pa) (Drs Vogt, Cauley, and Kuller); Department of Medicine, Medical College of Pennsylvania, Allegheny Campus, Pittsburgh (Dr Newman); and the Division of Clinical Epidemiology, Department of Epidemiology and Biostatistics, University of California, San Francisco (Dr Hulley).

Footnotes
Reprint requests to Department of Epidemiology, University of Pittsburgh, 130 DeSoto St, Pittsburgh, PA 15261 (Dr Vogt).

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References
Circulation 2002;106:3373-3421.
FULL TEXT  

Missed Opportunities to Treat Atherosclerosis in Patients Undergoing Peripheral Vascular Interventions: Insights From the University of Michigan Peripheral Vascular Disease Quality Improvement Initiative (PVD-QI2)
Mukherjee et al.
Circulation 2002;106:1909-1912.
ABSTRACT | FULL TEXT  

Prevention Conference VI: Diabetes and Cardiovascular Disease: Writing Group III: Risk Assessment in Persons With Diabetes
Redberg et al.
Circulation 2002;105 :e144-e152.
FULL TEXT  

Peripheral Arterial Occlusive Disease: Prognostic Value of Signs, Symptoms, and the Ankle-Brachial Pressure Index
Hooi et al.
Med Decis Making 2002;22:99-107.
ABSTRACT  

Alcohol Consumption and Risk of Peripheral Arterial Disease : The Rotterdam Study
Vliegenthart et al.
Am J Epidemiol 2002;155:332-338.
ABSTRACT | FULL TEXT  

Peripheral Arterial Disease Detection, Awareness, and Treatment in Primary Care
Hirsch et al.
JAMA 2001;286:1317-1324.
ABSTRACT | FULL TEXT  

Dietary Antioxidants and Peripheral Arterial Disease : The Rotterdam Study
Klipstein-Grobusch et al.
Am J Epidemiol 2001;154:145-149.
ABSTRACT | FULL TEXT  

Medical Treatment of Peripheral Arterial Disease and Claudication
Hiatt
NEJM 2001;344:1608-1621.
FULL TEXT  

Novel Risk Factors for Systemic Atherosclerosis: A Comparison of C-Reactive Protein, Fibrinogen, Homocysteine, Lipoprotein(a), and Standard Cholesterol Screening as Predictors of Peripheral Arterial Disease
Ridker et al.
JAMA 2001;285:2481-2485.
ABSTRACT | FULL TEXT  

The Minnesota Regional Peripheral Arterial Disease Screening Program: toward a definition of community standards of care
Hirsch et al.
Vasc Med 2001;6:87-96.
ABSTRACT  

Secondary prevention of coronary artery disease in patients undergoing elective surgery for peripheral arterial disease
Nass et al.
Vasc Med 2001;6:35-41.
ABSTRACT  

Determinants of Peripheral Arterial Disease in the Elderly: The Rotterdam Study
Meijer et al.
Arch Intern Med 2000;160:2934-2938.
ABSTRACT | FULL TEXT  

Improved Functional Outcomes Following Exercise Rehabilitation in Patients With Intermittent Claudication
Gardner et al.
Journals of Gerontology Series A: Biological Sciences and Medical Sciences 2000;55:570M-577.
ABSTRACT | FULL TEXT  

Hormone Replacement Therapy and Peripheral Arterial Disease: The Rotterdam Study
Westendorp et al.
Arch Intern Med 2000;160:2498-2502.
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Papoz et al.
ANGIOLOGY 2000;51:463-471.
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Greenland et al.
Circulation 2000;101 :e16-e22.
FULL TEXT  

Traditional Risk Factors and Subclinical Disease Measures as Predictors of First Myocardial Infarction in Older Adults: The Cardiovascular Health Study
Psaty et al.
Arch Intern Med 1999;159:1339-1347.
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Newman et al.
Arterioscler. Thromb. Vasc. Bio. 1999;19:538-545.
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Microalbuminuria and Peripheral Arterial Disease Are Independent Predictors of Cardiovascular and All-Cause Mortality, Especially Among Hypertensive Subjects : Five-year Follow-up of the Hoorn Study
Jager et al.
Arterioscler. Thromb. Vasc. Bio. 1999;19:617-624.
ABSTRACT | FULL TEXT  

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McGrae McDermott et al.
Arch Intern Med 1999;159:387-392.
ABSTRACT | FULL TEXT  

Comparison of Three Blood Pressure Methods Used for Determining Ankle/Brachial Index in Patients with Intermittent Claudication
Montgomery and Gardner
ANGIOLOGY 1998;49:723-728.
ABSTRACT  

The generalized nature of atherosclerosis: how peripheral arterial disease may predict adverse events from coronary artery disease
Criqui and Denenberg
Vasc Med 1998;3:241-245.
ABSTRACT  

Physical Activity is Related to Ankle/Brachial Index in Subjects Without Peripheral Arterial Occlusive Disease
Gardner et al.
ANGIOLOGY 1997;48:883-891.
ABSTRACT  

Carotid Atherosclerosis in Men With Low Levels of HDL Cholesterol
Wilt et al.
Stroke 1997;28:1919-1925.
ABSTRACT | FULL TEXT  

Intermittent Claudication : A Risk Profile From The Framingham Heart Study
Murabito et al.
Circulation 1997;96:44-49.
ABSTRACT | FULL TEXT  

Arterial Damage, Triglycerides, Apolipoprotein, and Lp-(a) Values in PVD Patients
Catalano et al.
CLIN APPL THROMB HEMOST 1997;3:104-109.
ABSTRACT  

Evaluation of Superficial Femoral Artery Compromise and Limb Growth Retardation After Transfemoral Artery Balloon Dilatations
Lee et al.
Circulation 1997;95:974-980.
ABSTRACT | FULL TEXT  

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Leng et al.
BMJ 1996;313:1440-1443.
ABSTRACT | FULL TEXT  

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Curb et al.
Arterioscler. Thromb. Vasc. Bio. 1996;16:1495-1500.
ABSTRACT | FULL TEXT  

Diagnosis and Treatment of Chronic Arterial Insufficiency of the Lower Extremities: A Critical Review
Weitz et al.
Circulation 1996;94:3026-3049.
FULL TEXT  

Correlates and Consequences of Diffuse Atherosclerosis in Men With Coronary Heart Disease
Wilt et al.
Arch Intern Med 1996;156:1181-1188.
ABSTRACT  

Prevalence and Correlates of Symptomatic Peripheral Atherosclerosis in Individuals with Coronary Heart Disease and Cholesterol Levels Less Than 240 mg/dL: Baseline Results from the Cholesterol And Recurrent Events (CARE) Study
Wilt et al.
ANGIOLOGY 1996;47:533-541.
ABSTRACT  

Subclinical Disease as an Independent Risk Factor for Cardiovascular Disease
Kuller et al.
Circulation 1995;92:720-726.
ABSTRACT | FULL TEXT  

Effect of Diagnostic Criteria on the Prevalence of Peripheral Arterial Disease : The San Luis Valley Diabetes Study
Hiatt et al.
Circulation 1995;91:1472-1479.
ABSTRACT | FULL TEXT  

The Predictive Capabilities of Clinical Tests: The 6-Minute Walk
Mark
JAMA 1994;271:661-662.
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Lerman
JAMA 1994;271:26-26.
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Lief
JAMA 1994;271:26-26.
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JWatch General 1993;1993:2-2.
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Applegate
JAMA 1993;270:497-498.
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