Ankle-Arm Index as a Predictor of Cardiovascular Disease and Mortality in the Cardiovascular Health Study
Abstract
Abstract —Peripheral arterial disease (PAD) in the legs, measured noninvasively by the ankle-arm index (AAI) is associated with clinically manifest cardiovascular disease (CVD) and its risk factors. To determine risk of total mortality, coronary heart disease, or stroke mortality and incident versus recurrent CVD associated with a low AAI, we examined the relationship of the AAI to subsequent CVD events in 5888 older adults with and without CVD. The AAI was measured in 5888 participants ≥65 years old at the baseline examination of the Cardiovascular Health Study. All participants had a detailed assessment of prevalent CVD and were contacted every 6 months for total mortality and CVD events (including CVD mortality, fatal and nonfatal myocardial infarction, congestive heart failure, angina, stroke, and hospitalized PAD). The crude mortality rate at 6 years was highest (32.3%) in those participants with prevalent CVD and a low AAI ( P <0.9), and it was lowest in those with neither of these findings (8.7%, P <0.01). Similar patterns emerged from analysis of recurrent CVD and incident CVD. The risk for incident congestive heart failure (relative risk [RR]=1.61) and for total mortality (RR=1.62) in those without CVD at baseline but with a low AAI remained significantly elevated after adjustment for cardiovascular risk factors. Hospitalized PAD events occurred months to years after the AAI was measured, with an adjusted RR of 5.55 (95% CI, 3.08 to 9.98) in those at risk for incident events. A statistically significant decline in survival was seen at each 0.1 decrement in the AAI. An AAI of <0.9 is an independent risk factor for incident CVD, recurrent CVD, and mortality in this group of older adults in the Cardiovascular Health Study.
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Patients with peripheral arterial disease who have a coronary artery disease history are at extremely high risk for total mortality and fatal cardiovascular events.
“Patients with PAD who have a CAD history are at extremely high risk for total mortality and fatal cardiovascular events761–767).”
From Japan Atherosclerosis Society (JAS) guidelines for prevention of atherosclerotic cardiovascular diseases 2017 (2018) · cites this paper as [761]
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Self-citation
- Authors
- Newman, A. B., Shemanski, L., Manolio, T. A., Cushman, M., Mittelmark, M., Polak, J. F., Powe, N. R., & Siscovick, D.
- Affiliations
- University of Vermont (US)
- Venue
- Arteriosclerosis, Thrombosis, and Vascular Biology
- Published
- 1999-03
- Volume
- 19
- Issue
- 3
- Pages
- 538-545
- ISSN
- 1079-5642 (ISSN-L)
- 1524-4636
- OpenAlex
- W2044609151
- Cited by
- 871
- References
- 33
- Citations by year
- 2026: 11 · 2025: 8 · 2024: 6 · 2023: 6 · 2022: 22 · 2021: 22 · 2020: 14 · 2019: 27 · 2018: 19 · 2017: 23 · 2016: 25 · 2015: 24 · 2014: 38 · 2013: 48 · 2012: 50
- FWCI
- 20.34
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Arteriosclerosis Thrombosis and Vascular Biology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (n01hc085083-027, n01hc085080-026)
- National Heart, Lung, and Blood Institute (N01HC-85083, N01HC85080, N-01-HL-85079)
- Topics
- Health Sciences › Medicine › Surgery › Peripheral Artery Disease Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Keywords
- ankle-brachial index, peripheral arterial disease, cardiovascular disease, mortality, stroke, coronary artery disease, congestive heart failure, myocardial infarction, older adults, cardiovascular risk factors, Cardiovascular Health Study
- MeSH terms
- Aged, Aged, 80 and over, Ankle, Arm, Blood Pressure Determination, Cardiovascular Diseases, Female, Humans, Hypertension, Male, Predictive Value of Tests, Risk Factors, Cohort Studies, Survival Analysis, Age Distribution, Sex Distribution
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