Pathological Ankle-brachial Index Research Articles

Low and High Ankle-Brachial Index Are Both Associated with Mortality in German Nursing Home Residents-The Five-Year Follow-Up of the "Allo-Study" Cohort.

Peripheral arterial disease (PAD) is associated with high cardiovascular morbidity and mortality. We aimed to examine this relation in a population that tends to be under-represented in research on the topic. In a prospective observational cohort study, residents of 45 nursing homes in Germany were screened for pathological ankle-brachial index (ABI) and observed for five years. Of 1333 participants (median age 84 years), 55.5% had a pathological ABI (≤0.9 or >1.4) on one or both legs. 84.7% of the probands with a low ABI (indicating PAD) had no previously known PAD diagnosis. The five-year mortality was 73.0%. Mortality was higher in individuals with a pathological ABI (76.5%) than in those with a normal ABI (68.7%, p = 0.003). An ABI > 1.4 was associated with a higher mortality (79.4%) than a reduced (74.7%) or normal ABI (68.7%, p = 0.011). Pathological ABI values were associated with an increase in mortality after correction for age, sex and all recorded comorbidities, including cardiac disease. Although PAD is highly prevalent in nursing home residents, it is underdiagnosed and undertreated. In the study cohort, both high and low ABI were important predictors of mortality. PAD deserves more attention in this high-risk population.

Post-Exercise Ankle–Brachial Index Is Reduced in Healthy, Young Individuals at a Level Indicating Peripheral Artery Disease

In young patients referred for exercise-induced pain in the legs, false positive tests are a potential problem for the post-exercise ankle–brachial index (ABI) test when using the current American Heart Association guidelines for diagnosing peripheral artery disease (PAD). The present study aimed to investigate post-exercise ABI in healthy young people, and to explore whether the current diagnostic criteria for pathological ABI should be revised. Forty-eight volunteers (18–30 years) were included. Resting examinations included ABI and ultrasound of the external iliac artery. Post-exercise examinations after a treadmill load included ABI and ultrasound of the external iliac artery; after 0 min and after 3 min. A total of 60.5% of the participants had a post-exercise decrease in ABI > 20%. A total of 6.5% showed a decrease in ankle systolic blood pressure >30 mmHg. No significant association was observed between a change in blood flow in the external iliac artery and a reduction in ABI post-exercise. Analyses of the ultrasound recordings showed no turbulence in the external iliac artery. According to the results, a 20% decrease in ABI post-exercise seems to be a physiological condition present in young people. We support the need for a reassessment of the criteria for diagnosing PAD.

The ankle-brachial index for assessing the prevalence of peripheral artery disease and cardiovascular risk in patients with type 2 diabetes mellitus

Background and aimsType 2 diabetes mellitus (T2DM) is an important risk factor for peripheral artery disease (PAD). Ankle-Brachial Index (ABI) was found associated with a higher cardiovascular (CV) risk and mortality. The main goals of this study were to establish the prevalence of PAD in a T2DM population, and assess the relationship between PAD and the CV risk calculated with the CUORE Project score (CPS) (https://www.cuore.iss.it/). The association between the ABI, the main risk factors for PAD and T2DM complications was also investigated. Methods and resultsTwo hundred patients were consecutively enrolled. The prevalence of PAD in this population was 17%. The CV risk tended to be higher (p = 0.0712) in the group with a pathological ABI than in the group with a normal ABI. Glycated hemoglobin (r = −0.1591; p = 0.0244), total cholesterol (r = −0.1958; p = 0.0054), LDL cholesterol (r = −0.1708; p = 0.0156) and systolic blood pressure (r = −0.1523; p = 0.0313) correlated significantly and inversely with the left ABI. The frequency of diabetic retinopathy was significantly higher in the group with a pathological ABI (p = 0.0316). ConclusionsThe data reveal a high prevalence of PAD in patients with T2DM. The CPS confirmed that patients with a pathological ABI have tendency to a higher CV risk. The results point to the importance of an accurate CV assessment – also measuring individuals’ ABI and calculating their CPS - to better pinpoint those at high risk of PAD, especially among patients with T2DM.

Lung Function Impairment Is Related to Subclinical Atherosclerosis Only in Active Smokers

Background: Although an association between lung function and subclinical atherosclerosis has been reported, it remains unclear whether this association is only driven by tobacco smoking. We aimed to assess this in a population with at least one cardiovascular risk factor. Methods: We recruited 6209 subjects aged between 45 and 70 years with at least one cardiovascular risk factor (excluding diabetes mellitus) participating in the ILERVAS project 2015–2018. Lung function was determined by spirometry. Subclinical atherosclerosis was assessed with the ankle–brachial index (ABI) and the presence of carotid and femoral plaques measured by ultrasound. Results: A total of 5927 subjects were included: 49% male, median (p25–p75) age 57 years (52–62). Plaques were found in 4337 (73.2%) of the subjects. The patients with atherosclerosis showed worse lung function: median forced expiratory volume in one second (FEV1) 95% and forced vital capacity (FVC) 94% in the patients with plaques vs. 99% and 98% in the other patients (p < 0.001). Adjusted models stratified by smoking status showed that being in the lower quartiles of FEV1 % was associated with carotid and femoral plaques (OR 1.599, p = 0.005; and OR 1.654, p = 0.006), whereas FVC % was inversely associated with carotid plaques (OR 0.967, p = 0.041). A pathological ABI was associated with worse FEV1 (OR 1.971, p = 0.038) and the presence of airway obstruction (OR 1.658, p = 0.015). However, these differences were restricted to current smokers. Conclusions: Lung function impairment was correlated with subclinical atherosclerosis only in current smokers. This highlights the unique role of smoking-related vascular and pulmonary dysfunction in early stages of pulmonary and cardiovascular afflictions.

Ankle-brachial index: more than a diagnostic test?

The ankle-brachial index (ABI) is the relationship between the systolic blood pressure taken at the ankle level and the brachial artery. A pathological ABI (<0.90 or >1.40) indicates the presence of peripheral artery disease (PAD). Many studies indicate the great utility of this test in the diagnosis of PAD due to its ease of use, reproducibility, low cost, and high cost-effectiveness. This evaluation can be directly correlated with cardiovascular morbidity and mortality; however, it has recently been confirmed that a low ABI can be a predictor of major cardiovascular events, as it is related to diabetes mellitus, chronic coronary disease, stroke, and more. The objective of this work was to review the current evidence on the importance of ABI in the diagnosis of PAD and its main role as a predictor of cardiovascular morbidity and mortality.

Long-Term Morbidity and Mortality after First and Recurrent Cardiovascular Events in the ARTPER Cohort.

Background: Cardiovascular events are a major cause of mortality and morbidity worldwide. The risk of recurrence after a first cardiovascular event has been documented in the international literature, although not as extensively in a Mediterranean population-based cohort with low cardiovascular risk. There is also ample, albeit contradictory, research on the recurrence of stroke and myocardial infarctions (MI) after a first event and the factors associated with such recurrence, including the role of pathological Ankle-Brachial Index (ABI). Methods: The Peripheral Arterial ARTPER study is aimed at deepening our knowledge of patient evolution after a first cardiovascular event in a Mediterranean population with low cardiovascular risk treated at a primary care centre. We study overall recurrence, cardiac and cerebral recurrence. We studied participants in the ARTPER prospective observational cohort, excluding patients without cardiovascular events or with unconfirmed events and patients who presented arterial calcification at baseline or who died. In total, we analyzed 520 people with at least one cardiovascular event, focusing on the presence and type of recurrence, the risk factors associated with recurrence and the behavior of the ankle-brachial index (ABI) as a predictor of risk. Results: Between 2006 and 2017, 46% of patients with a first cardiovascular event experienced a recurrence of some type; most recurrences fell within the same category as the first event. The risk of recurrence after an MI was greater than after a stroke. In our study, recurrence increased with age, the presence of peripheral arterial disease (PAD), diabetes and the use of antiplatelets. Diabetes mellitus was associated with all types of recurrence. Additionally, patients with an ABI < 0.9 presented more recurrences than those with an ABI ≥ 0.9. Conclusions: In short, following a cardiac event, recurrence usually takes the form of another cardiac event. However, after having a stroke, the chance of having another stroke or having a cardiac event is similar. Lastly, ABI < 0.9 may be considered a predictor of recurrence risk.

Subclinical atherosclerosis due to increase of plasma aldosterone concentrations in essential hypertensive individuals.

The adrenal mineralocorticoid system plays a key role in cardiovascular, metabolic and renal damage. This study aimed to assess the relationship between plasma aldosterone concentration (PAC) and some surrogate markers of subclinical atherosclerosis, such as carotid intima-media thickness (cIMT), ankle-brachial index (ABI) and biochemical parameters in patients with essential hypertension. From January 2014 to December 2017, we consecutively enrolled 804 essential hypertensive patients (407 men and 397 women, mean age 50 ± 14 years) without cardiovascular complications, distinguishing patients in quartiles according to PAC. Compared with the first quartile, the highest PAC quartile was associated with the highest levels of serum uric acid (SUA) (5.3 ± 1.3 vs. 5.0 ± 1.0 mg/dl; P = 0.01), triglycerides (117.5 ± 15.7 vs. 106.8 ± 10.5 mg/dl; P < 0.05), 24-h urinary albumin excretion (UAE) (38.8 ± vs. 7.6 ± mg/24 h; P < 0.05), cIMT (0.87 ± 0.22 vs. 0.80 ± 0.21 mm; P = 0.001) and increased prevalence of carotid plaques (26 vs. 16%; P < 0.005). Moreover, we found that in patients with PAC more than 150 pg/ml, the ABI was significantly lower than those with PAC < 150 pg/ml (1.01 ± 0.09 vs. 1.10 ± 0.09; P < 0.022). PAC was also found to be an independent predictor of the presence of carotid plaques and pathological ABI (<0.9) in essential hypertensive individuals. Our results revealed that higher PAC values are strongly associated with some metabolic variables, as triglycerides, UAE, cIMT, worse ABI and major prevalence of carotid plaques that, together with elevated blood pressure values, are strictly correlated with higher risk of atherosclerosis and cardiovascular complications.

Peripheral arterial disease of the lower limbs in Moroccan hypertensive non-diabetic patients

Peripheral arterial disease (PAD) of the lower limbs is only an aspect of a general vascular disease; PAD announces cardiovascular accidents. Thus, the early screening of PAD is a major issue. To evaluate the prevalence of PAD of the lower limbs in asymptomatic patients with hypertension and to determine the risk factors or associations of risk factors most frequently responsible of pathological (< 0.9) ankle-brachial index (ABI). We conducted a prospective survey including 273 patients from November 2016 to December 2017 in our department. The mean population's age was 62.09 years (27–88 years), with a male predominance gender (67,76%). The prevalence of PAD was 28.94%. Risk factors or association of risk factors that were significantly associated with PAD (Chi 2 Pearson test) were: the male gender (72%), tobacco use (56%), obesity (BMI ≥ 30) 15.8%, dyslipidemia and grade-3 hypertension (23.4%). PAD of the lower limbs is a particular location of the atheromatous process as well as a marker of its diffusion. As a result of this study, we recommend the screening of asymptomatic PAD in all hypertensive patients by measuring the ankle-brachial index.

SUBCLINICAL ATHEROSCLEROSIS, SERUM URIC ACID AND PLASMA ALDOSTERONE IN HYPERTENSIVE ADULTS

Objective: aldosterone has long been classically considered to play a central role in the regulation of electrolyte and fluid volume and the maintenance of blood pressure (BP) homeostasis. Moreover, the aldosterone/mineralocorticoid system plays a key role in cardiovascular, metabolic and renal damage. This study aimed to assess the relationship between plasma aldosterone concentration (PAC) and some surrogate markers of subclinical atherosclerosis, such as carotid intima-media thickness (cIMT), ankle-brachial index (ABI) and biochemical parameters (i. e. serum uric acid – SUA, 24-h urinary albumin excretion - UAE) in subjects with essential hypertension (EH). Design and method: from January 2014 to December 2017 we consecutively enrolled 804 EH patients (407 males and 397 females, mean age 50 ± 14.5 yrs) without evident cardiovascular complications. Patients were divided in quartiles according to PAC levels. Results: Compared to the first quartile, the highest PAC quartile was associated with the highest levels of SUA (5.3 ± 1.34 vs 5.0 ± 1 mg/dl; p = 0.01) triglycerides (117.5 ± 15.7 vs 106.8 ± 10.5 mg/dl; p < 0.05), UAE (38.8 vs 17.6 mg/24ore; p < 0.05) and cIMT (0.87 ± 0.22 mm vs 0.8 ± 0.21 mm; p = 0.001). Patients of the fourth quartile also exhibited increased prevalence of carotid plaques, compared to the first quartile (26% vs. 16%; p < 0.005). Moreover, we found that in patients with PAC >160 pg/ml ABI was significantly lower compared to those with PAC < 160 pg/ml (1.01 ± 0.09 vs 1.1 ± 0.09; p < 0.022). Binary logistic regression analysis showed that PAC was an independent predictor of the presence of carotid plaques and pathological ABI (< 0.9) in the population examined. Conclusions: These findings suggest that higher values of PAC are strongly associated with higher values of SUA, triglycerides, UAE, cIMT, worse ABI and major prevalence of carotid plaques that, together with elevated BP values, are strictly correlated with higher risk of atherosclerosis and cardiovascular complications.

PRESENCE OF ASYMPTOMATIC PERIPHERAL ARTERY DISEASE AMONG HYPERTENSIVE PATIENTS WITH CORONARY DISEASE

Objective: The aim of the study is to evaluate the presence of asymptomatic peripheral artery disease among hypertensive patients with coronary disease and its association with the severity of coronary artery disease. Design and method: The study enrolled 150 examinees divided into two groups. The patients with hypertension and coronary disease constituted the first group (n = 100); the second group consisted of the healthy examinees–control group (CG, n = 50). For all patients there was determined: presence of risk factors for cardiovascular disease (hypertension, hyperlipidemia, smoking, diabetes, obesity, age), laboratory analyses, anthropometric measurements, ankle–brachial index (ABI) and coronarography. Results: In the first group the average number of atherosclerosis involved coronary blood vessels was 2.22 ± 0.81, in 46.0% observed in three blood vessels, in 30.0% in two, in 24.0% in one vessel. The average value of ABI in CG was significantly higher (p < 0.01). All controls had ABI in the normal range. Pathological value ABI was found in 59% patients in I group, 41,0% had reduced ABI, 18.0% higher values. The value of ABI was lowest in patients with three blood vessels affected and significantly lower than in those with one affected blood vessel (p < 0.01). In patients with a single blood vessel affected, it was more common to have normal and increased ABI compared to those with three (p < 0.05) and much more rarely lower ABI values compared to those with two and three (p < 0.001) affected blood vessels. With each increase of ABI, valued by one unit of measurement, the number of involved blood vessels dropped by 1.298, p < 0.01. As the most important factors associated with the number of coronary blood vessels affected by atherosclerosis, multivariate regression analysis singled out ABI, CV risk score and waist-hip ratio. The multivariate analysis of variance indicates significant individual effects of the ABI index (F = 2.71, p < 0.05), SCORE risk (p < 0.001) and age (p < 0.01) per set of percentages of stenosis of all single coronary arteries. Conclusions: More than half of coronary patients with hypertension have asymptomatic peripheral artery disease. Our results have shown that reduced ABI were in correlation with the severity of coronary disease assessed based on the number of affected coronary blood vessels.

68-OR: The Combined Impact of ABI and TcPO2 on Three-Year Mortality in Patients with Type 2 Diabetes and Foot Ulcers

A diabetic foot ulcer (DFU) is associated with increased cardiovascular risk and mortality independently of ulcer etiology (ischemic, neuro-ischemic or neuropathic). Traditional cardiovascular risk factors can partly, but not alone explain this risk increment. Ankle-brachial index (ABI) is the most commonly used test when diagnosing peripheral vascular disease and is also considered a marker for increased cardiovascular risk. However, ABI do not reflect microvascular dysfunction, a condition often seen in DFU patients. Transcutaneous oxygen pressure (TcPO2) is considered to better evaluate microvascular function and has in previous studies shown correlations with both wound healing and survival. The aim of this study was to evaluate the combined impact of a low TcPO2 (&amp;lt; 30 mmHg) and a pathological ABI (&amp;lt; 0.8 or ≥1.4) on 3-year mortality rates in patients with DFU. We evaluated 202 type 2 diabetic patients with DFU, aged 18-85 years. As shown in the Figure, individuals with a combination of pathological ABI and low TcPO2 had the worst survival rates, with 3-year mortality of 54%, compared to 42% in those with pathological ABI alone and 21% in those with normal ABI/TcPO2. Age did not differ between groups (median 75, 75, 74 years respectively). In conclusion, combining ABI and TCPO2 in routine assessment could provide additional predictive information when risk stratifying patients with type 2 diabetes and DFU. Disclosure K. Fagher: Speaker's Bureau; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Merck Sharp &amp; Dohme Corp., Novo Nordisk A/S, Sanofi. M. Londahl: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Novo Nordisk A/S, Sanofi. Speaker's Bureau; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Novo Nordisk A/S, Sanofi. Funding Swedish Diabetes Foundation; Skåne County Councils Research and Development Foundation; Lund University

The relationship of pathological ankle-brachial index and cognitive decline in patients after ischemic stroke

To identify associations between cognitive impairment and values of ankle-brachial index (ABI) in patients after ischemic stroke at discharge from the hospital and over one-year follow-up. The study included 375 patients with normal (n=192) and elevated (n=153) ABI who underwent ischemic stroke (IS). Neurological examination was performed using NIHSS, the Rankin scale, Barthel index, Rivermead Mobility Index at discharge from the hospital and over one-year follow-up. Patients with elevated ABI had marked cognitive impairment and more severe neurological deficit compared to patients with normal ABI. Evaluation of ABI can help in predicting the development of post-stroke cognitive impairment in patients with IS.

Cardiovascular Risk Factors in Cluster Headache.

Patients with cluster headache tend to have a dysregulation of systemic blood pressure such as increased blood pressure variability and decreased nocturnal dipping. This pattern of nocturnal nondipping is associated with end-organ damage and increased risk of cardiovascular disease. To determine if cluster headache is associated with a higher risk of cardiovascular disease. Cross-sectional study of 33 cluster headache patients without evidence of cardiovascular disease and 30 age- and gender-matched healthy controls. Ambulatory blood pressure monitoring was performed in all subjects. We evaluate anthropometric, hematologic, and structural parameters (carotid intima-media thickness and ankle-brachial index). Of the 33 cluster headache patients, 16 (48.5%) were nondippers, a higher percentage than expected. Most of the cluster headache patients (69.7%) also presented a pathological ankle-brachial index. In terms of the carotid intima-media thickness values, 58.3% of the patients were in the 75th percentile, 25% were in the 90th percentile, and 20% were in the 95th percentile. In the control group, only five of the 30 subjects (16.7%) had a nondipper pattern ( P = 0.004), with 4.54% in the 90th and 95th percentiles ( P = 0.012 and 0.015). Compared with healthy controls, patients with cluster headache presented a high incidence (48.5%) of nondipper pattern, pathological ankle-brachial index (69.7%), and intima-media thickness values above the 75th percentile. These findings support the hypothesis that patients with cluster headache present increased risk of cardiovascular disease.

Circulating angiotensin converting enzyme 2 activity as a biomarker of silent atherosclerosis in patients with chronic kidney disease

Background and aimsCirculating Angiotensin Converting Enzyme 2 (ACE2) activity in chronic kidney disease (CKD) patients without previous history of cardiovascular disease (CVD) has been associated with classical risk factors (older age, diabetes and male gender). Furthermore, silent atherosclerosis has been described as a pathological link between CKD and CVD. We analyzed baseline ACE2 activity in non-dialysis CKD stages 3–5 (CKD3-5) patients as a biomarker of renal progression, silent atherosclerosis and CV events after 2 years of follow-up. MethodsProspective study of 1458 CKD3-5 subjects without any previous CV event included in the Spanish multicenter NEFRONA study. Association between baseline circulating ACE2 activity and renal parameters, carotid/femoral echography, atheromatous disease, ankle-brachial index, intima-media thickness, need of renal replacement therapy, cardiovascular events and mortality at 24 months of follow-up were analyzed. ResultsPatients with an increase in the number of territories with plaques at 24 months showed significantly higher levels of baseline ACE2 activity as compared to stable patients (29.6 (20.6–47.6)RFU/μL/h versus 35.7 (24.5–56), p < 0.001). Multivariate linear regression analysis showed that male gender, pathological ankle-brachial index and progressive silent atherosclerosis defined as an increased number of territories with plaques at 24 months were associated with increased baseline ACE2 activity. Male gender, older age, diabetes, smoking and increased baseline circulating ACE2 were independent predictors of atherosclerosis at 24 months of follow-up. ConclusionsIn CKD3-5 patients, higher circulating ACE2 activity at baseline is associated with higher risk for silent atherosclerosis, suggesting that ACE2 may serve as a biomarker to predict CV risk before CVD is established.

Factors influencing pathological ankle-brachial index values along the chronic kidney disease spectrum: the NEFRONA study.

The ankle-brachial index (ABI) is widely used to diagnose subclinical peripheral artery disease (PAD) in the general population, but data assessing its prevalence and related factors in different chronic kidney disease (CKD) stages are scarce. The aim of this study is to evaluate the prevalence and associated factors of pathological ABI values in CKD patients. NEFRONA is a multicentre prospective project that included 2445 CKD patients from 81 centres and 559 non-CKD subjects from 9 primary care centres across Spain. A trained team collected clinical and laboratory data, performed vascular ultrasounds and measured the ABI. PAD prevalence was higher in CKD than in controls (28.0 versus 12.3%, P < 0.001). Prevalence increased in more advanced CKD stages, due to more patients with an ABI ≥1.4, rather than ≤0.9. Diabetes was the only factor predicting both pathological values in all CKD stages. Age, female sex, carotid plaques, higher carotid intima-media thickness, higher high-sensitivity C-reactive protein (hsCRP) and triglycerides, and lower 25-hydroxi-vitamin D were independently associated with an ABI ≤0.9. Higher phosphate and hsCRP, lower low-density lipoprotein (LDL)-cholesterol and dialysis were associated with an ABI ≥1.4. A stratified analysis showed different associated factors in each CKD stage, with phosphate being especially important in earlier CKD, and LDL-cholesterol being an independent predictor only in Sage 5D CKD. Asymptomatic PAD is very prevalent in all CKD stages, but factors related to a low or high pathological ABI differ, revealing different pathogenic pathways. Diabetes, dyslipidaemia, inflammation and mineral-bone disorders play a role in the appearance of PAD in CKD.

Carotid Intima-Media Thickness is Not Associated with Markers of Atherosclerosis in Stroke Patients

It has been argued that carotid intima-media thickness (IMT) could better reflect an adaptive response of the vessel wall rather than being a marker of atherosclerosis. We explore this hypothesis by analyzing the ARTICO data. The ARTICO study was designed to evaluate the prognostic value of the pathological ankle-brachial index (ABI) for the emergence of new vascular events in patients who have suffered a noncardioembolic stroke. Collected variables were as follows: vascular risk factors, mean waist perimeter, quantification of carotid IMT, characteristics of carotid plaques, ABI, and presence of microalbuminuria. A total of 591 patients with a complete carotid evaluation were available. There was no correlation between ABI and IMT (Spearman's, p NS). Logistic regression revealed that pathological ABI correlated significantly only with internal carotid artery stenosis greater than or equal to 50% (OR [odds ratio] 2.80, 1.66-4.71, P < .01) and peripheral artery disease (OR 3.33, 1.63-6.78, P < .01). However, multivariate regression analysis demonstrated that carotid IMT was independently associated with age (OR 1.05, 95% confidence interval [CI] 1.02-1.09, P < .01), hypertension (OR 1.83, 95% CI 1.02-3.26, P = .04), waist circumference (OR 1.03, 95% CI 1.01-1.05, P < .01), and microalbuminuria (OR 2.02, 95% CI 1.22-3.35, P < .01). In our patients, carotid IMT does not seem to be associated with unequivocal markers of atheromatosis such as the existence of relevant carotid plaques or pathological ABI. These results as well as the association of IMT with age, hypertension, microalbuminuria, and mean waist perimeter support the hypothesis that IMT must be considered a risk factor for general vascular disease rather than a marker of atherosclerotic burden.

FACTORS ASSOCIATED WITH A PATHOLOGIC ANKLE-BRACHIAL INDEX IN PATIENTS WITH STROKE: GENDER DIFFERENCES

Today remains a topical issue of studying risk factors for stroke. One such factor is the level of pathological ankle-brachial index and gender sensitive. Purpose. The purpose of the study. To examine gender-specific factors associated with a pathologic ankle-brachial index (ABI) in patients with acute violation of cerebral circulation (cerebral vascular accident). Materials and methods. The patients were evaluated with the presence of cardiovascular disease, previous cardiovascular events, type, and subtype of stroke, neurological status. To assess the presence of atherosclerosis performed color duplex scanning of brachycephalic arteries and laboratory studies (lipid profile). Results. In the present study, no significant differences in the value of ABI in men and women with acute ischemic stroke (37.0 and 42.3 % respectively, p=0, 29). However, there are gender differences in factors associated with the presence of a pathological ABI. Independent factors associated with abnormal ABI in men, are the increased levels of LDL cholesterol (p=0.02), KIM thickening (p=0.04), presence of bilateral stenosis GCA (p=0.0002) and extent of stenosis of the carotid arteries (p=0.03); in women – only the presence of bilateral stenosis GCA (p=0.03). Conclusions. Evaluation of LPI is appropriate in patients with stroke, regardless of gender to identify the groups with increased risk of subsequent cardiovascular events and for targeted preventive actions.

ANNUAL FORECAST IN PATIENTS WITH ACUTE ISCHEMIC STROKE: ROLE OF PATHOLOGICAL ANKLE-BRACHIAL INDEX

Aim . To study the factors associated with a poor annual prognosis in patients with acute stroke and prognostic role of pathological ankle-brachial index (ABI). Material and methods . The study included 345 patients (age 63.6±7.8 years, 181 males and 164 females) with ischemic stroke that were observed for 1 year. All patients were divided into 2 groups: Group 1 included patients with favorable annual outcome of stroke; Group 2 included patients that during a year had any clinical events including death. All patients underwent a standard neurological and instrumental examination including assessment of peripheral arteries status by sphygmomanometry. Results. Both groups did not differ by age and sex. The frequency of unfavorable outcomes (death, re-stroke, cardiovascular events) 1 year after ischemic stroke was 29.5%. Chronic heart failure, atrial fibrillation, previous cardiovascular events, presence of peripheral atherosclerosis, overweight were identified most commonly in Group 2. Patients of Group 2 initially had a rough neurological deficit. The pathological ABI was detected in 70.7% of patients in Group 2 vs 33.8% of patients in Group 1 (p=0.000001). A strong relationship of pathological ABI with a poor outcome of stroke was found by regression analysis. Conclusions . Detection of pathological ABI in patients with ischemic stroke makes it possible to reveal peripheral atherosclerosis and to carry out the targeted preventive measures in these patients. Risk stratification can contribute to more individual and effective secondary prevention in patients with cerebrovascular disease.

Adding low ankle brachial index to classical risk factors improves the prediction of major cardiovascular events. The REGICOR study.

Cardiovascular risk estimation is a key element of current primary prevention strategies, despite its limited accuracy. Several biomarkers are being tested to assess their capacity to improve coronary (CHD) and cardiovascular (CVD) prediction. One of these biomarkers is ankle brachial index (ABI). The aim of this study was to assess whether the inclusion of ABI improved the predictive capacity of the Framingham-REGICOR risk function in an area of low CVD incidence. A total of 5248 individuals, aged 35-74 years, from a prospective population-based cohort study were followed up for a median 5.9 years. Baseline ABI was measured using a standardized method. All incident CHD (angina, myocardial infarction, coronary revascularization, CHD death) and CVD (also including fatal and non-fatal stroke) events were recorded. Improvements in discrimination (ΔC-statistics) and reclassification by net reclassification index (NRI) were assessed. During follow-up, 111 and 64 subjects presented with a coronary or cerebrovascular event. Pathological ABI (≤0.9) was associated with increased CHD and CVD risk (HR: 2.08 and HR: 2.24, respectively; p-value<0.001). Including ABI in the Framingham-REGICOR function improved both its discrimination and its reclassification capacity for CVD events but not for CHD events; the ΔC-statistic for CVD events was 0.007 (95% Confidence Interval: 0.001; 0.017) and the NRI was 0.029 (95% CI: 0.014-0.045; p-value<0.001). Inclusion of the ABI improves the predictive capacity of the Framingham-REGICOR risk function. The study results indicate the potential value of including this simple test in cardiovascular risk stratification and support current guidelines recommendations.

Markers of cardiovascular risk in patients with antiphospholipid syndrome: A meta-analysis of literature studies

Several studies reported on the association between antiphospholipid syndrome (APS) and venous thrombosis. In contrast, little is known about cardiovascular (CV) risk in APS. We performed a meta-analysis on the impact of APS on major markers of CV risk.Studies on the relationship between APS and common carotid artery intima-media thickness (CCA-IMT), internal carotid artery IMT (ICA-IMT), carotid bifurcation IMT (BIF-IMT), prevalence of carotid plaques, flow-mediated dilation (FMD), nitrate-mediated dilation (NMD), and ankle-brachial index (ABI) were systematically searched in PubMed, Web of Science, Scopus, and EMBASE databases. Twenty case-control studies (668 cases, 678 controls) were included. Compared to controls, APS patients showed a higher CCA-IMT (mean difference [MD] 0.11 mm; 95% CI 0.07, 0.14), ICA-IMT (MD 0.08 mm; 95% CI 0.05, 0.11), BIF-IMT (MD 0.09 mm; 95% CI 0.06, 0.12) and a higher frequency of carotid plaques (OR 3.87; 95% CI 1.61, 9.31). Moreover, a lower FMD was found in APS subjects than in controls (MD –4.49%; 95% CI –6.20, –2.78), with no differences in NMD (MD –1.80%; 95% CI –4.01, 0.42). Finally, an increased prevalence of pathological ABI was found in APS patients compared to controls (OR 7.26; 95% CI 1.77, 29.71).Despite heterogeneity among studies, APS appears significantly associated with markers of subclinical atherosclerosis and CV risk. These findings can be useful to plan adequate prevention strategies and therapeutic approaches.