Association Of Ankle-brachial Index Research Articles

Abstract 13580: Impact of Chronic Kidney Disease on the Association of Ankle Brachial Index With Cardiovascular and All-Cause Mortality

Introduction: The association of low Ankle brachial index (ABI) with increased risk of cardiovascular (CV) as well as all-cause mortality is well established. Similarly, there is an independent association of chronic kidney disease (CKD) with CV and all-cause mortality. Little is known about the association of low ABI with CV and all-cause mortality by CKD status. Methods: We used data on 4,614 subjects from the National Health and Nutritional Examination Survey (NHANES) from January 1, 1999, to December 31, 2002. Those with available data on ABI and CKD status were included. Subjects were categorized as: 1) normal ABI ( > 0.9), no CKD (eGFR > 60 ml/min/m 2 , reference), 2) normal ABI and CKD, 3) Abnormal ABI, no CKD, 4) Abnormal ABI and CKD. NHANES-linked National death index records were used to determine CV and all-cause mortality. We used Cox proportional-hazards models and controlled for age, race, gender, income, educational status, smoking history, diabetes, systolic blood pressure, HDL and total cholesterol levels and history of CV disease. Results: Mean age was 55.7 years with 51% females and 4% blacks. Low ABI was present in 7%, while 6.4% had CKD and 1.3% had both low ABI and CKD. Median follow-up was 10.3 years. ABI<0.9 was associated with risk of all-cause [Hazard ratio: 1.59 (95% confidence interval: 1.21-2.01)] and CV mortality [2.80 (1.72-4.56)] compared to normal ABI. Similarly, CKD was associated with risk of all-cause [1.34 (1.04-1.71)] and CV mortality [1.69 (1.0-2.96)] compared to no CKD. Among categories, the risk was [1.29 (0.9-1.8)], [1.57 (1.1-2.2)] and [1.92 (1.3-2.6)] for all cause mortality, and [1.2 (0.5-2.9)], [2.3 (1.3-4.0)] and [4.72, (2.6-8.4)] for CV mortality in groups normal ABI with CKD, abnormal ABI without CKD and abnormal ABI and CKD both, respectively compared to the reference group. Conclusion: Low ABI confers a much higher risk of CV and all-cause mortality in those with CKD than those without CKD. More aggressive risk factor modification might be warranted in those with CKD and low ABI to lower risk.

Abstract 17482: Association of Ankle-Brachial Index with Coronary Artery Calcium Scoring for Coronary Vascular Disease Risk Stratification

Introduction: The Ankle-Brachial Index (ABI) and coronary artery calcium scoring (CACS) are important tools for cardiovascular disease risk stratification. This study aimed to investigate the association between ABI index in combination with CACS for risk stratification of coronary vascular disease. Hypothesis: Given that both the ABI and the Coronary Artery Calcium Scoring are predictors of cardiovascular events, we hypothesize that an association between the Multiethnic Study on Subclinical Atherosclerosis Coronary Artery Calcium Scoring (MESA-CACS) and ABI exists. Methods: A total of 2655 patients (mean age 59±6 years, 72% male, and 87% white) who underwent CACS screening and ABI as part of a primary prevention screening program at the Cleveland Clinic between March 2016 and October 2021 were included in this study. ABI measurements were obtained by dividing the ankle systolic blood pressure by the brachial systolic blood pressure. The 10-year risk score based on MESA-CACS was calculated and categorized into 4 groups (<1%, 1-4.99%, 5-9.99% and ≥10%). ABI was categorized into normal (1-1.4), non-compressible (≥ 1.4) and abnormal (< 1). Results: Among the total of 2655 patients, 164 (6%) had a MESA-CAC score of <1%, 1566 (59%) had a score of 1-4.99%, 501 (19%) had a score of 5-9.99%, and 424 (16%) had a score of ≥10%. The median ABI was 1.17 (range 0.79-1.77) on the left and 1.17 (0.50-1.78) on the right. Tabulating the patients based on their ABI index across the MESA-CACS categories showed no significant difference among the groups with a p-value of 0.830 (Fig 1), with the majority of the patients (> 98% of patients) in all 4 groups having a normal ABI index of 1-1.4. Conclusion: The ABI did not demonstrate a significant association with the MESA-CACS, suggesting its potential use as a synergistic marker for coronary vascular disease risk stratification. Long-term cohort studies are needed to validate this result.

Clinical and psychological correlations with type D personality in patients with chronic coronary syndrome

Recently, it has become common to identify type D personality, which is predisposed to the development of psychological distress. Negative behavioral characteristics of individuals with type D personality contribute not only to the development of cardiovascular diseases, but also to other comorbid pathologies that can influence the progression and prognosis of coronary heart disease. The aim of the study. To identify clinical and psychological correlations with type D personality in patients with chronic coronary syndrome. Methods. The study included 113 patients (68 men and 45 women; median age – 64 years) admitted for planned percutaneous coronary intervention at the Research Institute for Complex Issues of Cardiovascular Diseases (Kemerovo, Russian Federation). Based on the results of the DS-14 test, patients were divided into two groups: patients with type D personality (n = 40) and patients without this type (n = 73). Results. In patients with chronic coronary syndrome with type D personality, compared with patients without this type, concomitant diabetes mellitus (35 % and 15 %, respectively; p = 0.018), signs of diastolic dysfunction of left (Е/е’ ratio 7.1 [6.48; 8.0] and 5.0 [4.55; 5.74], respectively; p = 0.0038) and right (Et/At ratio – 0.8 [0.66; 1.35] and 1.38 [1.28; 1.63], respectively; p = 0.014) ventricles were more often diagnosed. Correlation analysis revealed associations of diabetes mellitus with type D personality (r = 0.243; p = 0.011), severity of negative excitability (r = 0.253; p = 0.008) and social suppression (r = 0.224; p = 0.020), as well as association of ankle-brachial index (ABI) with the severity of negative excitability (r = 0.393; p = 0.004) and social suppression (r = 0.414; p = 0.002). Conclusion. In patients having chronic coronary syndrome with type D personality, concomitant diabetes mellitus, as well as left and right ventricular filling disorders are more often detected. Correlation analysis revealed associations of diabetes mellitus with type D personality and its subscales; the ABI level was associated with subscales of type D personality, but not with the level of anxiety and depression.

Association of ankle-brachial index with cognitive decline in patients with lacunar infarction.

Atherosclerosis is an important risk factor for cognitive decline. This study aimed to investigate the relationship of ankle-brachial pressure index (ABI) and brachial-ankle pulse wave velocity (baPWV) with cognitive function in patients with lacunar infarction. We included records of consecutive patients with their first-ever acute stroke and a diagnosis of lacunar infarction through magnetic resonance imaging (MRI) from July 1, 2011 to December 31, 2018. We excluded patients diagnosed with dementia, including strategic single-infarct dementia, before or after stroke onset. Moreover, we excluded patients with one or more microbleeds, severe white matter lesions, or severe medial temporal atrophy on MRI. For ABI, we used the lower ankle side and divided the results into ABI < 1.0 and ABI ≥ 1.0. For baPWV, we used the higher ankle side and divided the results into two groups based on the median value of the participants. We analyzed 176 patients with stroke (age 72.5 ± 11.4 years, 67 females). The median score on the Mini-Mental State Examination (MMSE) was 27. The number of patients with ABI < 1.0 was 19 (10.8%). Univariate analysis revealed that the MMSE score was associated with age, body mass index, education, chronic kidney disease, periventricular hyperintensity, and ABI < 1.0 (p < 0.10), but not baPWV. Multivariate analysis revealed that body mass index (p = 0.039) and ABI < 1.0 (p = 0.015) were independently associated with the MMSE score. For patients with lacunar infarction, a lower ABI, but not a higher PWV, was associated with cognitive decline.

The high normal ankle brachial index is associated with left ventricular hypertrophy in hypertension patients among the Han Chinese

Left ventricular hypertrophy (LVH) is the most common target organs damage in the hypertension patients. Abnormal low (≤0.9) or high (≥1.40) ankle brachial index (ABI) are associated with an increased risk of cardiovascular events. However, the relationships between a high ABI in the normal range (0.9–1.4) and LVH in Han Chinese hypertension are not entirely elucidated. This study included 3953 hypertension patients aged 40–75 years among Han Chinese. Hypertension was defined as systolic blood pressure≥140 mm Hg, diastolic blood pressure≥90 mm Hg, or history of antihypertensive drug use. Left ventricular mass (LVM) was measured by transthoracic echocardiography. LVH was diagnosed by using the criteria of LVM ≥49.2 g/m2.7 for men and 46.7 g/m2.7 for women. Our study suggested that the ABI was higher in patients with LVH than in those without (1.13±0.11, 1.11±0.11, p < 0.001). The prevalence of LVH in patients with the lowest (0.9 < ABI≤1.03), second (1.04≤ABI≤1.11), the third (1.12≤ABI≤1.20), and the highest quartile (1.21≤ABI < 1.40) of ABI was 37.2%, 38.2%, 45.5%, 45.7%, respectively. Logistic regression analysis suggested that the highest and third quartile of ABI were significantly associated with increased LVH risk (multivariate‐adjusted OR of highest group:1.83; third group:1.61). The association of ABI at second quartile with LVH was nonsignificant. Similar results were observed in less than 60 years and without coronary heart disease or diabetes group. Our observations in Chinese patients with hypertension indicated high ABI may be an important risk factor for LVH in hypertension patients among Han Chinese, even in the normal range.

1118-P: The Association of Ankle-Brachial Index and BMI with Pulmonary Disease in Type 1 Diabetes

In the general population, chronic obstructive pulmonary disease (COPD) and Preserved Ratio Impaired Spirometry (PRISm) have been shown to increase mortality risk. While increased respiratory disease risk has been observed in type 1 diabetes (T1D), data on PRISm and COPD, especially in middle-age, are scarce in T1D. We thus assessed correlates of COPD and PRISm among individuals with childhood-onset T1D. Data were from the 30-year visit of the EDC study (n=162, median age/T1D duration, 56/47 years). Pulmonary function was assessed with the NDD EasyOne™ Spirometer using NHANES reference values for the predicted values. COPD was defined as Forced Expiratory Volume in 1 Second (FEV1)/Forced Vital Capacity (FVC)<0.7. PRISm was defined as FEV1% predicted<80% and FEV1/FVC≥0.7. The majority of participants were classified as having COPD (43.2%) or PRISm (25.9%), with only 30.9% having normal pulmonary function. Univariate differences by pulmonary disease status are shown in the Table. Multinomial logistic regression models were constructed to assess independent correlates of COPD and PRISm. High ABI (>1.3) was associated with greater odds of COPD (OR=4.64, 95% CI: 1.42-15.13, p=0.01) and BMI with PRISm (OR=1.10, 95% CI: 1.01-1.21, p=0.03). No other risk factor was associated with COPD or PRISm.In conclusion, high ABI and BMI appear to be independently associated with greater odds of COPD and PRISm, respectively, in T1D.View largeDownload slideView largeDownload slide DisclosureJ. Ju: None. G. L. Kinney: None. R. G. Miller: None. T. J. Orchard: None. T. Costacou: None.FundingNational Institutes of Health (DK34818)

Association of Ankle Brachial Index with Clinical Outcomes Following Percutaneous Coronary Intervention in Patients with Aortic Aneurysm.

Objective Since patients with thoracic aortic aneurysm (TAA)/abdominal aortic aneurysm (AAA) are often complicated with coronary artery disease, it is common for those patients to undergo percutaneous coronary intervention (PCI). The ankle brachial index (ABI) is usually measured in patients with TAA/AAA to screen the presence of peripheral arterial disease. The present study investigated the association between the ABI and clinical outcomes following PCI in patients with TAA/AAA. Methods We divided 200 TAA/AAA patients who underwent PCI into a normal ABI group (n=137) and an abnormal ABI group (n=63) according to the ABI cut-off level of 1.00. The primary endpoint was one-year major adverse cardiovascular events (MACE), defined as the composite of cardiovascular death, non-fetal myocardial infarction, stroke, target vessel revascularization, and hospitalization for heart failure. Results Mean ABIs in the normal and abnormal ABI groups were 1.12±0.09 and 0.86±0.11, respectively (p<0.01). Kaplan-Meier curves showed MACE were more frequent in the abnormal ABI group than in the normal ABI group (p=0.01). A multivariate Cox hazard analysis revealed that an abnormal ABI was significantly associated with 1-year MACE (vs. ABI ≥1.0: HR 3.02, 95% confidence interval 1.00-9.08, p=0.049). Conclusion Among patients with TAA/AAA who underwent PCI, abnormal ABI was significantly associated with 1-year MACE, suggesting the utility of the ABI measurement in this high-risk population.

ASSOCIATION OF ANKLE BRACHIAL INDEX WITH CARDIOVASCULAR AND SOCIODEMOGRAPHIC RISK FACTORS IN DIABETIC POPULATION

Lower-extremity arterial occlusive disease is much more likely to occur in patients with type II diabetes. Due to rapidly increasing prevalence of Diabetes and its dreadful complications like amputation and associated mortality, it is crucial to screen symptomatic as well as asymptomatic diabetic patients for peripheral arterial disease (PAD) at an early stage. There is immense evidence stating increased risk of coronary vascular disease(CVD) and PAD in diabetics. The risk factors being similar to that of CVD, there is less information available regarding association of Ankle brachial index with individual cardiovascular risk factors in diabetic population. This study was done with the objective to evaluate association of Ankle Brachial Index (ABI) with Physical activity level, chronicity of Diabetes Mellitus ,cardiovascular risk factors and sociodemographic factors. Methods:Type 2 diabetic patients coming to diabetic-endocrinology OPD of tertiary care hospital were evaluated for Fasting Blood Sugar, Serum Total cholesterol and Serum Triglycerides, International Physical Activity Questionnaire- long form (IPAQ LF). ABI was evaluated and interpreted as per guidelines of American Heart Association. Data was analyzed using SPSS for windows version 16 software. Results: Total 500 patients (male=271, female=229) with mean age 57.85 (± 9.66) years participated in the study. The association of ABI was statistically signicant with Physical activity level (p= 0.005), chronicity of Diabetes Mellitus (p&lt; 0.001), Glycemic control (p= 0.02), Serum Total Cholesterol (p &lt;0.001) and Serum Triglycerides (p = 0.032). The association of ABI with Waist circumference (p=0.307) and Smoking (p= 0.380) was statistically not signicant. The study also revealed signicant association of ABI with age (&lt;0.001), gender (&lt;0.001), weekly sitting time (p= 0.002), presence of claudication symptom (0.019), annual family income (p= 0.021)and family history of diabetes mellitus (p= &lt;0.001). Conclusions: This study revealed signicant association of Ankle Brachial Index with cardiovascular risk factors and socio-demographic parameters.

Abstract 14158: Ankle-brachial Index and Risk of Severe Ischemic Leg Outcomes in a Community-based Population: The Atherosclerosis Risk in Communities (ARIC) Study

Introduction: Ankle-brachial index (ABI) ≤ 0.9 is used to define lower-extremity peripheral artery disease (PAD). However, the association between ABI and severe ischemic leg outcomes in the general population has not been investigated. Hypothesis: Lower ABI is independently associated with risk of severe ischemic leg outcomes. Methods: We studied 13,742 ARIC participants (median age 54 [SD 5.75] years, 45% males) without intermittent claudication or a history of revascularization for PAD at baseline (1987-89). We quantified the association of ABI with risk of severe ischemic leg outcomes using Cox regression. ABI was modeled as a restricted cubic spline allowing for potentially non-linear associations. Severe ischemic leg outcomes were ascertained through ICD codes and included critical limb ischemia (CLI) (defined as PAD with rest pain or tissue loss) and ischemic leg amputation (amputations with PAD diagnosis). Results: Over a median of 28 years of follow-up, there were 221 and 129 events of CLI and ischemic leg amputation, respectively. Lower ABI was linearly associated with both CLI and ischemic leg amputation (Figure). With ABI 1.25 as the reference, adjusted hazard ratios of CLI were 2.48 (95% CI 1.15-5.36) at ABI 0.7, 1.97 (1.30-2.99) at ABI 0.9, and 1.73 (1.18-2.54) at ABI 1.0. The corresponding hazard ratios of ischemic leg amputation were 3.57 (1.44-8.81), 2.63 (1.54-4.48), and 2.23 (1.34-3.70), respectively. The association was largely consistent in demographic and clinical subgroups, although the results were less evident in younger and female participants compared to their counterparts. Conclusions: In middle-aged adults without clinical PAD, lower ABI was independently and linearly associated with higher risk of severe ischemic leg outcomes. Our results support the value of ABI as an indicator for leg vascular condition and also indicate that ABI 0.9-1.1 should not be considered normal for ischemic leg prognosis.

Impact of Body Mass Index on the Association of Ankle-Brachial Index With All-Cause and Cardiovascular Mortality: Results from the National Health and Nutrition Examination Survey.

ObjectiveTo assess the influence of body-mass index (BMI) on the association of ankle-brachial index (ABI) with mortality.Patients and MethodsWe conducted a prospective study of National Health and Nutrition Examination Survey participants enrolled from January 1, 1999 to December 31, 2002 with BMI and ABI data available. ABI categories were <0.9 (low), 0.9 to 1.3 (reference), and >1.3 (high). BMI categories were <30 kg/m2 (nonobese) and ≥30 kg/m2 (obese). Cardiovascular (CV) and all-cause mortality were assessed by National Death Index records. Cox proportional-hazards models and Kaplan-Meier survival estimates were used to compare groups.ResultsIn total, 4614 subjects were included, with mean age 56±12 years and BMI 28±6 kg/m2. Median follow-up was 10.3 years (interquartile range [IQR]: 9.3 to 11.4 years). Low and high ABI were present in 7% and 8%, respectively. After adjustment, low ABI was associated with increased all-cause and CV mortality in nonobese (hazard ratio [HR] 1.5, 95% CI, 1.1-2.1 for all-cause and 3.0 [1.8-5.1] for CV mortality) and obese individuals (1.8 [1.2-2.7] and 2.5 [1.2-5.6], respectively) compared with reference. High ABI was associated with increased CV mortality in nonobese (2.2 [1.1-4.5]) but not obese patients; it was not associated with all-cause mortality overall or when stratified by BMI.ConclusionIn a US cohort, weight influenced the prognostic significance of high ABI. This may be related to technical factors reducing compressibility of the calf arteries in obese persons compared with those who are nonobese.

P946Abnormal ankle brachial indices are associated with ischemic stroke: evidence from a large cohort study

Abstract Background Peripheral arterial disease is a marker of aggressive atherosclerosis. The ankle brachial index (ABI) is a simple and non-invasive tool to diagnose peripheral arterial disease (PAD). Patients with PAD are at increased risk for ischemic strokes and other cardiovascular diseases. Purpose To evaluate the association of abnormal ABI and poorly compressible vessels with ischemic stroke in a large patient cohort. Methods We analyzed lower extremity vascular studies of all patients with ABI measurements at a tertiary care hospital between January 1996 and August 2018. PAD is defined as ABI&lt;1.0, and poorly or non-compressible (PC/NC) arteries as ABI&gt;1.4 while ABI between 1.0–1.4 is normal. Association of these ABIs with new ischemic stroke events post ABI measurement were analyzed after adjusting for high risk confounders such as atrial fibrillation. Hazard ratios (HR) were calculated using multivariable Cox proportional regression with 95% confidence intervals. Results In total, 38,016 unique patients (mean age 66.1±14.8 years, female 42.3%) were included. Abnormal ABI was found to be more prevalent among elderly male patients compared to patients with normal ABI. In contrast to non-PAD patients, both PAD and PC/NC patients as defined by ABI had a statistically significant risk of ischemic stroke, with PAD conferring the greatest risk compared to PC/NC vessels. The data is summarized in Table 1. Table 1 Unadjusted HR p-value Adjusted HR p-value PAD vs. No PAD 2.77 (2.62, 2.92) &lt;0.001 2.10 (1.98, 2.22) &lt;0.001 PC/NC vs. No PAD 2.11 (1.95, 2.28) &lt;0.001 1.38 (1.26, 1.51) &lt;0.001 PAD vs. PC/NC 1.37 (1.28, 1.46) &lt;0.001 1.37 (1.28, 1.48) &lt;0.001 Adjusted and unadjusted hazard ratios with p-values. HR adjusted for age, sex, atrial fibrillation, ischemic stroke, transient ischemic attack, chronic heart failure, diabetes mellitus, hyperlipidemia, hypertension, and coronary artery disease. PAD = Peripheral artery disease and PC/NC = poorly compressible/non-compressible. Conclusion This study adds to the growing body of evidence that PAD and poorly-compressible vessels are independently associated with an increased risk of ischemic stroke. Given the associated risk of cerebrovascular disease, clinicians should aggressively treat to minimize risk factors in those with abnormal ABIs.

SUN-289 Association of Ankle brachial index with renal function in Indian Chronic Kidney Disease (ICKD) cohort

Patients with chronic kidney disease (CKD) experience higher rates of cardiovascular disease (CVD) events and mortality. The risk of peripheral arterial disease (PAD), as measured by ankle-brachial index (ABI) is also increased in CKD. The prevalence of reduced glomerular filtration rate (eGFR) and a low ABI increase with aging. In this study, we assessed the association of biochemical parameters, eGFR with ABI in ICKD cohort.

Association of Ankle-Brachial Index with the Angiographic Severity of Patient with Coronary Artery Disease

Background: The Ankle-Brachial Index has been shown to be a good marker of systemic atherosclerosis and a powerful indicator of cardiovascular morbidity and mortality This study evaluated the relation of ABI with the angiographic severity of patient with coronary artery disease.Methods: This is a hospital based cross-sectional analytical study. 100 adult Bangladeshi patients who were admitted and underwent coronary angiography according to inclusion and exclusion criteria were the study population. All patient’s ABI were measured and coronary angiography were done. Patients were divided into two groups according to ABI. Group I with ABI &gt;0.90 and group II with ABI &lt;0.90.Results: In group I 65(82.2%) were men and 16(19.8%) were women. In group II 18(94.7%) patients were men and 1(5.3%) was women. Significant co-relation was found between low ABI and severity of CAD. Low ABI group showed more severe form of CAD with higher prevalence of triple vessel diseases, significant stenosis and more involvement of left main (LM) and left anterior descending(LAD)artery. Single vessel disease was found more with normal ABI. Hypertension, diabetes mellitus and Low ABI showed predictors of significant severe stenosis of coronary arteries.Conclusion: Low ankle brachial index is a predictor of the severity of coronary artery disease. So it could be incorporated in our day to day clinical cardiology practice as non-invasive, bedside test to assess and predict the severity of coronary artery disease.Cardiovasc. j. 2018; 10(2): 201-205

Risk factors for patients with diabetes who have abnormal toe-brachial index and normal ankle-brachial index.

To investigate the association of ankle-brachial index (ABI) and toe-brachial index (TBI) with metabolic parameters and the risk factors causing a divergence between ABI and TBI in patients with diabetes. Outpatients who were simultaneously examined for both ABI and TBI were included. Multiple regression analysis was performed to assess the association of ABI and TBI with metabolic parameters. Furthermore, logistic regression analysis was performed to detect the risk factors causing a divergence between ABI and TBI. Of the 307 patients that were enrolled, 77 had normal ABI but decreased TBI. ABI was inversely associated with plasma glucose and triglycerides and positively associated with high-density lipoprotein cholesterol. In contrast, TBI was inversely associated with the duration of diabetes, plasma glucose and haemoglobin A1c. Logistic regression analysis showed that smoking history and a history of cardiovascular disease were associated with an increased risk of the divergence between ABI and TBI. Our findings suggest that smoking history and a history of cardiovascular disease are important risk factors in patients with diabetes who had normal ABI but decreased TBI. Patients with multiple vascular complications are at a high risk of coexisting peripheral artery disease, even if their ABI is normal.

The Association of Ankle Brachial Index, Protein-Energy Wasting, and Inflammation Status with Cardiovascular Mortality in Patients on Chronic Hemodialysis.

Protein-energy wasting (PEW) is highly prevalent in hemodialysis (HD) patients. We investigated the association of abnormal ankle brachial index (ABI), PEW, and chronic inflammation status with clinical prognosis in HD patients. A total of 973 HD patients were enrolled and were followed-up for 8 years. As a marker of the PEW, geriatric nutritional risk index (GNRI) was used. Cut-off levels were 91.2 for GNRI defined from previous studies and 1.9 mg/L for C-reactive protein (CRP) as median value, respectively. Abnormal ABI was seen in 332 (34.1%) patients. Declined GNRI and elevated CRP levels were independently associated with abnormal ABI (odds ratio (OR) 0.97, 95% confidence interval (CI) 0.96–0.99, p = 0.0009 and OR 1.40, 95% CI 1.07–1.83, p = 0.013, respectively). GNRI levels were also independently correlated with CRP levels (β = −0.126, p < 0.0001). During follow-up period, 283 (29.1%) patients died, including 123 (12.6%) due to cardiovascular disease (CVD). Abnormal ABI (adjusted hazard ratio (HR) 1.62, 95% CI 1.13–2.32, p = 0.0096), GNRI < 91.2 (adjusted HR 1.57, 95% CI 1.06–2.33, p = 0.023) and CRP > 1.9 mg/L (adjusted HR 1.89, 95% CI 1.31–2.77, p = 0.0007) independently predicted mortality due to CVD, respectively. In conclusion, abnormal ABI, GNRI, and CRP levels were closely associated with each other, and the combination of these variables increase their predictive values for the risk of mortality due to CVD and all-cause mortality in HD patients.

ASSOCIATION OF ANKLE BRACHIAL INDEX WITH LIMB OUTCOMES IN PERIPHERAL ARTERY DISEASE: A COMMUNITY-BASED STUDY

Background: Peripheral artery disease (PAD) can lead to severe limb ischemia and limb loss. We conducted a community-based study to investigate the association of ankle brachial index (ABI) with incident limb outcomes in PAD patients. Methods: We identified 1413 PAD cases in Olmsted County,

Ankle-brachial index and brachial-ankle pulse wave velocity are associated with albuminuria in community-based Han Chinese

ABSTRACTBackground/objectives: Our study aimed to explore whether the ankle-brachial index (ABI) and brachial-ankle pulse wave velocity (baPWV) were associated with albuminuria in community-based Han Chinese. Methods: Total 2127 subjects (860 men and 1267 women) aged 60 years and over were recruited in Beijing. Albuminuria was assessed by the urinary albumin-to-creatinine ratio (UACR) of ≥30 mg/g. BaPWV was divided by quartile. The logistic regression was used to determine the odds ratio (OR) and 95% confidence intervals (CIs) of ABI and baPWV with albuminuria. Results: ABI was associated with albuminuria in the interaction model (OR 0.89, 95% CI 0.81–0.99 by every 0.1 unit increase of ABI), especially in hypertension (OR 0.82, 95% CI 0.73–0.92) and diabetes (OR 0.83, 95% CI 0.68–0.98) groups. BaPWV groups were also significantly associated with albuminuria, ORs of having albuminuria for baPWV quartile II, III, and IV were 1.02(0.65–1.52), 1.05(0.72–1.61), and 1.18(1.04–1.47) in the interaction model. For hypertension and diabetes patients, only the baPWV quartile IV group had higher OR. Conclusions: ABI and baPWV were associated with albuminuria after adjusting for other risk factors in Chinese community-based elderly Han population. The association of ABI with albuminuria was stronger in hypertension and diabetes patients.

Ankle Brachial Index and Subsequent Cardiovascular Disease Risk in Patients With Chronic Kidney Disease.

BackgroundThe clinical implications of ankle‐brachial index (ABI) cutpoints are not well defined in patients with chronic kidney disease (CKD) despite increased prevalence of high ABI attributed to arterial stiffness. We examined the relationship of ABI with cardiovascular disease (CVD) and all‐cause mortality among CKD patients.Methods and ResultsThree thousand six hundred twenty‐seven participants without clinical peripheral artery disease (PAD) at baseline from the Chronic Renal Insufficiency Cohort Study were included. ABI was obtained per standard protocol and CVD events were confirmed by medical record adjudication. A U‐shaped association of ABI with PAD, myocardial infarction (MI), composite CVD, and all‐cause mortality was observed. Individuals with an ABI between 1.0 and <1.4 had the lowest risk of outcomes. Compared to participants with an ABI between 1.0 and <1.4, multiple‐adjusted hazard ratios (95% confidence intervals) for those with an ABI of <0.9, 0.9 to <1.0, and ≥1.4 were 5.78 (3.57, 9.35), 2.76 (1.56, 4.88), and 4.85 (2.05, 11.50) for PAD; 1.67 (1.23, 2.29), 1.85 (1.33, 2.57), and 2.08 (1.10, 3.93) for MI; 1.51 (1.27, 1.79), 1.39 (1.15, 1.68), and 1.23 (0.82, 1.84) for composite CVD; and 1.55 (1.28, 1.89), 1.36 (1.10, 1.69), and 1.00 (0.62, 1.62) for all‐cause mortality, respectively.ConclusionsThis study indicates that ABI <1.0 was related to risk of PAD, MI, composite CVD, and all‐cause mortality whereas ABI ≥1.4 was related to clinical PAD. These findings suggest that ABI cutpoints of <1.0 or ≥1.4 for diagnosing PAD and ABI <1.0 for CVD risk stratification should be further evaluated among CKD patients.

Abstract P334: Ankle-Brachial Index and Future Diabetes: the Atherosclerosis Risk in Communities (ARIC) Study

Introduction: Individuals with peripheral artery disease (PAD) often experience reduced physical function and activity, which may increase the future risk of diabetes. Although diabetes is a risk factor of PAD, whether low ankle-brachial index (ABI) predates diabetes has not been studied. Hypothesis: Low ABI is independently associated with increased risk of incident diabetes. Methods: ABI was measured on a randomly selected leg in 12,244 black and white participants without prevalent diabetes at baseline (1987-1989). Incident diabetes cases were identified by glucose measurements (fasting ≥126 mg/dl or non-fasting ≥200 mg/dl) at subsequent three visits (1990-92, 1993-95, and 1996-98) and self-reported diagnosis or medication use at those visits or during annual phone interview through 2011. We examined the association of ABI with incident diabetes after accounting for potential confounders using Cox proportional hazards models. Results: A total of 3304 participants developed diabetes during a median of 21 years of follow-up. Participants with low (&lt;=0.9) or borderline low (0.9-1.0) ABI had 30-40% higher risk of future diabetes as compared to those with ABI of 1.1-1.2 in the demographically adjusted model (Table 1). The associations were attenuated after further adjustment for other potential confounders but remained significant for ABI 0.9-1.0 (HR=1.17, 95%CI 1.04-1.31), even after accounting for fasting glucose at baseline (P=0.046). The association were also attenuated for ABI &lt;=0.9 (HR=1.19 [95% CI 1.00-1.43]) and remained borderline significant in model adjusting for confounders except fasting glucose. The association of low ABI with diabetes was more evident in persons with normal glucose (fasting glucose &lt;100 mg/dl) than in those with impaired fasting glucose (100-125 mg/dl). Conclusions: Low ABI was mildly but independently associated with increased risk of incident diabetes in the general population. Attentions are needed regarding diabetes risk and glucose trajectory among people with low ABI.

Abstract P158: Lower Extremity Peripheral Artery Disease and Quality of Life among Older Individuals in the Community: The Atherosclerosis Risk in Communities (ARIC) Study

Background: Lower extremity peripheral arterial disease (PAD), commonly identified by an ankle-brachial Index (ABI) &lt;0.9, increases mortality risk and may impair mobility as well as quality of life (QOL). However, most studies assessing reduced QOL in the relation to PAD rely on small data from vascular clinics, leaving uncertainty about the impact of PAD on QOL in the community. Method: Using 5,610 ARIC visit 5 (2011-2013) participants aged 66-90 years, we assessed the associations of ABI with several QOL parameters, including self-evaluated general health status, mental status (the Center for Epidemiologic Studies Depression [CES-D] score and hopeless feeling), social aspect (work interfered by pain and social activity interfered by health status), and physical ability (limited ability to climb stairs and need of walking assistance). Logistic regression models were applied to assess the association of ABI with each QOL parameter, adjusting for potential confounders including comorbidities such as history of heart failure, coronary heart disease, and stroke. Result: With ABI 1.1-1.2 as a reference, lower ABI was consistently associated with poor status of all QOL parameters tested (Table), with overall evident dose-response relationship. Interestingly, a poor status of various QOL parameters was observed even in borderline low ABI (0.9-1.0) and low normal (1.0-1.1). High ABI (&gt;1.3), indicative of arterial stiffness, was only significantly associated with limited ability to climb stairs. Similar results for low ABI and QOL were observed in both genders and white and black participants. Conclusion: Low ABI was independently and consistently associated with poor status of wide range of QOL domains, with potential important implications on quality-maintained life in older individuals. Further studies are warranted to assess whether the association is due to PAD-related leg symptoms or weakness and/or reflects the impact of systemic atherosclerosis on QOL.