This Article  • Full text  • PDF  • CME Course for This Article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Topic Collections  • Cardiovascular System  • Quality of Care  • Evidence-Based Medicine  • Review  • Prognosis/ Outcomes  • Cardiovascular Disease/ Myocardial Infarction  • Alert me on articles by topic  Social Bookmarking   What's this?

A Meta-analysis

Ankle Brachial Index Collaboration

JAMA. 2008;300(2):197-208.

Context  Prediction models to identify healthy individuals at high risk of cardiovascular disease have limited accuracy. A low ankle brachial index (ABI) is an indicator of atherosclerosis and has the potential to improve prediction.

Objective  To determine if the ABI provides information on the risk of cardiovascular events and mortality independently of the Framingham risk score (FRS) and can improve risk prediction.

Data Sources  Relevant studies were identified. A search of MEDLINE (1950 to February 2008) and EMBASE (1980 to February 2008) was conducted using common text words for the term ankle brachial index combined with text words and Medical Subject Headings to capture prospective cohort designs. Review of reference lists and conference proceedings, and correspondence with experts was conducted to identify additional published and unpublished studies.

Study Selection  Studies were included if participants were derived from a general population, ABI was measured at baseline, and individuals were followed up to detect total and cardiovascular mortality.

Data Extraction  Prespecified data on individuals in each selected study were extracted into a combined data set and an individual participant data meta-analysis was conducted on individuals who had no previous history of coronary heart disease.

Results  Sixteen population cohort studies fulfilling the inclusion criteria were included. During 480 325 person-years of follow-up of 24 955 men and 23 339 women, the risk of death by ABI had a reverse J-shaped distribution with a normal (low risk) ABI of 1.11 to 1.40. The 10-year cardiovascular mortality in men with a low ABI (0.90) was 18.7% (95% confidence interval [CI], 13.3%-24.1%) and with normal ABI (1.11-1.40) was 4.4% (95% CI, 3.2%-5.7%) (hazard ratio [HR], 4.2; 95% CI, 3.3-5.4). Corresponding mortalities in women were 12.6% (95% CI, 6.2%-19.0%) and 4.1% (95% CI, 2.2%-6.1%) (HR, 3.5; 95% CI, 2.4-5.1). The HRs remained elevated after adjusting for FRS (2.9 [95% CI, 2.3-3.7] for men vs 3.0 [95% CI, 2.0-4.4] for women). A low ABI (0.90) was associated with approximately twice the 10-year total mortality, cardiovascular mortality, and major coronary event rate compared with the overall rate in each FRS category. Inclusion of the ABI in cardiovascular risk stratification using the FRS would result in reclassification of the risk category and modification of treatment recommendations in approximately 19% of men and 36% of women.

Conclusion  Measurement of the ABI may improve the accuracy of cardiovascular risk prediction beyond the FRS.

Ankle Brachial Index Collaboration Authors: F. G. R. Fowkes , G. D. Murray , I. Butcher , C. L. Heald , R. J. Lee (coordinating center); L. E. Chambless , A. R. Folsom , A. T. Hirsch (Atherosclerosis Risk in Communities [ARIC] Study); M. Dramaix , G. deBacker , J-C. Wautrecht , M. Kornitzer (Belgian Physical Fitness Study); A. B. Newman , M. Cushman , K. Sutton-Tyrrell (Cardiovascular Health Study); F. G. R. Fowkes , A. J. Lee , J. F. Price (Edinburgh Artery Study); R. B. d’Agostino , J. M. Murabito (Framingham Offspring Study); P. E. Norman , K. Jamrozik (Health in Men Study); J. D. Curb , K. H. Masaki , B. L. Rodríguez (Honolulu Heart Program); J. M. Dekker , L. M. Bouter , R. J. Heine , G. Nijpels , C. D. A. Stehouwer (Hoorn Study); L. Ferrucci , M. M. McDermott (InCHIANTI Study); H. E. Stoffers , J. D. Hooi , J. A. Knottnerus (Limburg PAOD Study); M. Ogren , B. Hedblad (Men Born in 1914 Study); J. C. Witteman , M. M. B. Breteler , M. G. M. Hunink , A. Hofman (Rotterdam Study); M. H. Criqui , R. D. Langer , A. Fronek (San Diego Study); W. R. Hiatt , R. Hamman (San Luis Valley Diabetes Study); H. E. Resnick (Strong Heart Study); J. Guralnik , M. M. McDermott (Women's Health and Aging Study).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Markers of Atherosclerosis and Inflammation for Prediction of Coronary Heart Disease in Older Adults
Rodondi et al.
Am J Epidemiol 2010;:kwp428v1-kwp428.
ABSTRACT | FULL TEXT  

Assessment of Claims of Improved Prediction Beyond the Framingham Risk Score
Tzoulaki et al.
JAMA 2009;302:2345-2352.
ABSTRACT | FULL TEXT  

Photoplethysmography, an Easy and Accurate Method for Measuring Ankle Brachial Pressure Index: Can Photoplethysmography Replace Doppler?
Khandanpour et al.
VASC ENDOVASCULAR SURG 2009;43:578-582.
ABSTRACT  

Low Ankle-Brachial Index Predicts Cardiovascular Risk After Acute Ischemic Stroke or Transient Ischemic Attack
Busch et al.
Stroke 2009;40:3700-3705.
ABSTRACT | FULL TEXT  

The Ankle-Brachial Index as a Biomarker of Cardiovascular Risk: It's Not Just About the Legs
Perlstein and Creager
Circulation 2009;120:2033-2035.
FULL TEXT  

Association of Asymptomatic Peripheral Arterial Disease With Vascular Events in Patients With Stroke or Transient Ischemic Attack
Sen et al.
Stroke 2009;40:3472-3477.
ABSTRACT | FULL TEXT  

Women and ischemic heart disease: evolving knowledge.
Shaw et al.
J Am Coll Cardiol 2009;54:1561-1575.
ABSTRACT | FULL TEXT  

Using Nontraditional Risk Factors in Coronary Heart Disease Risk Assessment: U.S. Preventive Services Task Force Recommendation Statement
U.S. Preventive Services Task Force
ANN INTERN MED 2009;151:474-482.
ABSTRACT | FULL TEXT  

Emerging Risk Factors for Coronary Heart Disease: A Summary of Systematic Reviews Conducted for the U.S. Preventive Services Task Force
Helfand et al.
ANN INTERN MED 2009;151:496-507.
ABSTRACT | FULL TEXT  

Peripheral Levels of Fibrinogen, C-Reactive Protein, and Plasma Viscosity Predict Future Cognitive Decline in Individuals Without Dementia
Marioni et al.
Psychosom. Med. 2009;71:901-906.
ABSTRACT | FULL TEXT  

The role of biomarkers and genetics in peripheral arterial disease.
McDermott and Lloyd-Jones
J Am Coll Cardiol 2009;54:1228-1237.
ABSTRACT | FULL TEXT  

Association of chronic kidney disease with the spectrum of ankle brachial index the CHS (Cardiovascular Health Study).
Ix et al.
J Am Coll Cardiol 2009;54:1176-1184.
ABSTRACT | FULL TEXT  

Metabolic Syndrome, Inflammation, and Risk of Symptomatic Peripheral Artery Disease in Women: A Prospective Study
Conen et al.
Circulation 2009;120:1041-1047.
ABSTRACT | FULL TEXT  

Advances in Measuring the Effect of Individual Predictors of Cardiovascular Risk: The Role of Reclassification Measures
Cook and Ridker
ANN INTERN MED 2009;150:795-802.
ABSTRACT | FULL TEXT  

Aspirin and Secondary Prevention in Peripheral Artery Disease: A Perspective for the Early 21st Century
McDermott and Criqui
JAMA 2009;301:1927-1928.
FULL TEXT  

Serum Selenium and Peripheral Arterial Disease: Results From the National Health and Nutrition Examination Survey, 2003-2004
Bleys et al.
Am J Epidemiol 2009;169:996-1003.
ABSTRACT | FULL TEXT  

The Year in Atherothrombosis
Sanz et al.
J Am Coll Cardiol 2009;53:1326-1337.
FULL TEXT  

C-Reactive Protein and Prognosis in Diabetes: Getting to the Heart of the Matter
Sattar and Hingorani
Diabetes 2009;58:798-799.
FULL TEXT  

Rethinking the Morbidity of Peripheral Arterial Disease and the "Normal" Ankle-Brachial Index
Gornik
J Am Coll Cardiol 2009;53:1063-1064.
FULL TEXT  

Treadmill Exercise and Resistance Training in Patients With Peripheral Arterial Disease With and Without Intermittent Claudication: A Randomized Controlled Trial
McDermott et al.
JAMA 2009;301:165-174.
ABSTRACT | FULL TEXT  

The peripheral arterial disease subgroup in the CHARISMA trial: does it tell us anything new?
Gresele and Migliacci
Eur Heart J 2009;0:ehn565v1-2.
FULL TEXT  

Atherosclerotic Peripheral Vascular Disease Symposium II: Executive Summary
Creager et al.
Circulation 2008;118:2811-2825.
FULL TEXT  

Atherosclerotic Peripheral Vascular Disease Symposium II: Screening for Atherosclerotic Vascular Diseases:: Should Nationwide Programs Be Instituted?
Criqui et al.
Circulation 2008;118:2830-2836.
FULL TEXT  

Progression of Peripheral Arterial Disease Predicts Cardiovascular Disease Morbidity and Mortality
Criqui et al.
J Am Coll Cardiol 2008;52:1736-1742.
ABSTRACT | FULL TEXT  

Can Measuring the Ankle-Brachial Index Improve Public Health?
Hiatt
J Am Coll Cardiol 2008;52:1743-1744.
FULL TEXT  

Aspirin for prevention of cardiovascular events
Hiatt
BMJ 2008;337:a1806-a1806.
FULL TEXT  

All you need to read in the other general journals
BMJ 2008;337:a774-a774.
FULL TEXT