Prevalence Of Low Ankle-brachial Index Research Articles

Estimating the Correlation of Ankle Brachial Index with Vascular Risk Factors in Pre-diabetics

Background: Prediabetes is characterized by a long duration of insulin resistance and increased fasting plasma glucose. Among the various risk factors for cardiovascular atherosclerosis and prediabetes, insulin resistance is one of them. Glycemia has been recognized to affect microvascular damage as compared to macrovascular damage. The ankle-brachial index (ABI) is a simple, affordable and non-invasive test as compared to angiography and has been found to have a high sensitivity and accuracy for the diagnosis of PAD, the gold-standard diagnostic method. This index is based on the fact that in healthy people, systolic blood pressure in the legs is typically equal to or marginally greater than in the upper limbs. This study aims to assess the correlation of ABI with vascular risk factors among subjects with Prediabetes like anthropometric measurement like BMI, Waist hip ratio and neck circumference.
 Methods: This will be a observational cross sectional study. The present research will involve a cluster of prediabetic subjects. ABI will be determined for all patients. Anthropometric measurements will be taken and blood investigations will be conducted. All data will be compiled and analyzed with appropriate statistical tests.
 Expected Results: We expect a significant association between prevalence of low ABI in prediabetics and heart problems.
 Conclusion: This research will highlight the adequate clinical and sociological assessment of pre-diabetes patients, including those who have been diagnosed for a long period of time.

Prevalence and associated risk factors of peripheral artery disease in virologically suppressed HIV-infected individuals on antiretroviral therapy in Kwara state, Nigeria: a cross sectional study

BackgroundThe association between HIV and cardiovascular disease (CVD) has been reported in several studies. However, there is paucity of information on the prevalence of subclinical disease as well as its associated risk factors in sub-Saharan African population. The aim of this study was to determine the prevalence and associated risk factors of peripheral artery disease (PAD) among virologically suppressed HIV-infected participants in Kwara State, Nigeria.MethodsThis study was conducted between July 2018 and December 2018. A total of 150 HIV-infected participants aged between 20 and 55 years and 50 HIV non-infected age-matched controls were randomly recruited in the study. Sociodemographic, anthropometric and clinical data were collected using a well-structured questionnaire. Ankle brachial index (ABI) was measured, PAD was defined as ABI of < 0.9. Cryopreserved serum was used to evaluate lipid profile parameters. Student’s t-test and Chi-square were used to compare continuous and categorical variables. Associations of CVD risk factors and clinical data, and lipid profile with low ABI were assessed using logistic regression analysis.ResultsThe study participants had a mean age of 43.73 ± 8.74, majority were females (72.7%) with a mean duration on ART of 7.73 ± 3.52 years. Hypertension was present in 15.9%, diabetes 4%, family history of CVD 8.6% and metabolic syndrome 17.3% in the study group. The study participants recorded significantly lower mean values for ABI, HDL-C and significantly higher mean values of TG (P < 0.05) compared to the control group. The prevalence of low ABI (14.6%) was higher in the study group compared to the control group (2%). A significantly negative correlation between ABI and duration on ART (r = − 0.163, P = 0.041) and a positive correlation between viral load and TG were observed in the study group. TC (OR 1.784, P = 0.011), LDL-C (OR 1.824, P = 0.010) and CD4 cell count < 200 cells/mm3 (OR 2.635, P = 0.364) were associated with low ABI in the participants.ConclusionViral suppression with combined antiretroviral therapy and long term treatment is associated with dyslipidaemia, with increased risk of PAD. Prevalence of PAD in virologically-suppressed individuals does not differ from the controls in the population studied.

A study to find out prevalence of low ankle-brachial index in patients of ischemic heart disease

Background: The ankle-brachial index (ABI) is the ratio of systolic pressure at the ankle and systolic pressure at the arm. ABI is a tool to diagnose the peripheral arterial disease (PAD) and it has been shown to predict mortality and adverse cardiovascular (CV) events. Aims and Objectives: This study was aimed to collect the data pertaining to diagnostic value of ABI and its prevalence in patients of ischemic heart disease. Materials and Methods: A cross-sectional descriptive-analytic study was done by the measurement of ABI on patients undergoing coronary angiography admitted in the Idaho Central Credit Union and Cath Lab at V. S. General Hospital, Ahmedabad. Statistical analysis was done using the SPSS 23.0 version. Univariate analysis was performed by applying the Pearson Chi-squared test. Results: According to the present study, the prevalence of low ABI in patients undergoing cardiac angiography is very low 4.6% and among those patients, true positives confirmed by peripheral angiography or Doppler studies were 91%. The association between a low ABI and CV risk factors such as smoking, hypertension, and diabetes is significant. Conclusion: ABI is a simple and cost-effective mode of diagnosis of PAD. It can identify the involvement of coronaries as an early intervention.

To Determine the Relation Between Ankle-Brachial Index with Angiographic Stenosis and Major Cardiovascular Risk Factors In Patients With Suspected Coronary Artery Disease.

Aims and Objectives: Prevalence of low Ankle-Brachial Index (ABI) in patients with Ischaemic Heart Disease. To compare the relationship between various physiological parameters like age, sex, and BMI with ABI. To compare the relationship between low ABI and number of coronaries involved.&#x0D; Methodology: Inclusion Criteria: All the 1423 patients aged 23-90 years including 1047 male and 376 female undergoing coronary angiography in VS hospital. Exclusion Criteria: Critically ill or who had severe limb ischemia or patients with amputation were excluded. Statistical analysis was done by using SPSS 20.0 version. Univariate analysis was performed by applying the Pearson chi-squared test.&#x0D; Results: In this study, 1423 patients were evaluated out of which 66 (4.6%) patients had ABI&lt;0.9. Out of 66 patients with low ABI 60 (91%) were male and 6 (9%) were female, showing high prevalence in the male. In patients having low ABI shows 12 (18.2%) have SVD, 11(16.7%) have DVD, 26(39.4%) have TVD, comparing this with patients having normal ABI, shows P value of 0.035 which is significant. 411 patients were diabetic including 40 (60.6%) patients having low ABI and 371 (27.3%) patients having normal ABI, shows P value of 0.000 which is highly significant.&#x0D; Conclusion: ABI is helpful in identifying individuals at high risk of coronary involvement. Although the prevalence of low ABI in patients with IHD is 4.6% that is very low but is highly specific (91%). In patients with ischemic heart disease low ABI suggests the involvement of multivessel disease. Direct association between ABI and significant Coronary Artery Disease noted.

Prognostic implications of the Ankle Brachial Index in patients with acute ischemic stroke: A meta-analysis

ABSTRACTBackground: The ankle brachial index (ABI) is recognized as a marker of atherosclerotic disease. The detection of ABI may improve the risk stratification.Methods: We systematically searched Pubmed and Embase (from the earliest date to October 2015) for studies evaluating the prognostic value of ABI in patients with acute ischemic stroke. Stroke or cardiovascular events, mortality and functional outcomes were analyzed.Results: Seventeen studies, containing 9404 patients, were included. The mean age of participants in each study ranged from 64 to 79 years. The prevalence of low ABI varied from 7.4% to 40.5%. In this quantitative analysis, we found that low ABI increased the risk of composite outcomes (myocardial infarction or stroke or mortality), disability and mortality.Conclusion: The detection of ABI may help to identify high-risk patients for secondary stroke prevention.

Pattern of ankle brachial index among adults in Sagamu South-West Nigeria

Background: The ankle-brachial index (ABI) is a ratio of Doppler recorded ankle and brachial systolic blood pressure. ABI value of Objectives: To determine the pattern of ABI, the prevalence of PAD, and the risk factors for low ABI. Subjects and Methods: Four hundred subjects aged 50 years and above were selected by systematic random sampling. Their demographic data and cardiovascular risk factors were assessed, and their ABI was measured. ABI value of ≤0.9 was taken as low ABI indicating PAD while a value >1.3 was taken as high ABI indicating arterial calcification. Results: Two hundred and eighty-eight (72.0%) of the participants had normal ABI, 99 (24.8%) had low ABI indicating PAD, and 13 (3.3%) had high ABI. The prevalence of low ABI increased from 4.9% between 50 and 59 years to 25.3% and 58.7% between 60 and 69 and ≥70 years, respectively. The risk factors for low ABI were age (P = 0.00), history of hypertension (P = 0.03), and diabetes mellitus (DM) (P = 0.00). Conclusion: 24.8% of the participants had low ABI indicating PAD. The prevalence of PAD increases by 5–10 folds after the fifth decade of life. Low ABI was associated with advancing age, DM, and hypertension.

Prevalence of macro- and microvascular complications in patients with type 2 diabetes and kidney disease with or without albuminuria in a single Chinese Diabetes Centre.

To investigate the relationship between diabetic retinopathy, neuropathy and low ankle-brachial index in mild-to-moderate chronic kidney disease of type 2 diabetic patients. We enrolled 875 type 2 diabetic patients who were divided into two phenotypes (with or without albuminuria) and stratified into three groups (stage 1 with estimated glomerular filtration rate ⩾ 90 mL/min/1.73 m(2), stage 2 with estimated glomerular filtration rate of 60-89, stage 3 with estimated glomerular filtration rate of 30-59). The prevalence of diabetic retinopathy, neuropathy and low ankle-brachial index was compared and the risk factors of renal impairment were determined. Among chronic kidney disease stages, the prevalence of diabetic retinopathy increased from 42.5%, 56.6% to 66.7% in albuminuric subjects and from 29.4%, 33.0% to 50.0% with no significant trend in normoalbuminuric subjects (p = 0.005, 0.007 and 0.399 compared with albuminuric subjects in each stage). There was a significantly increased prevalence of low ankle-brachial index (17.5%, 22.6% and 44.4%) in normoalbuminuric subjects but no significant trend in albuminuric subjects. Diabetic retinopathy (odds ratio = 2.474, 95% confidence interval = 1.009-6.068) was an independent risk factor of declining kidney function in albuminuric patients. The prevalence of diabetic retinopathy was graded according to the estimated glomerular filtration rate declining in albuminuric patients while the prevalence of low ankle-brachial index was gradually increased in normoalbuminuric patients, indicating the diverse underlying mechanisms of mild to moderate chronic kidney disease between these two phenotypes.

Peripheral Arterial Disease in Systemic Lupus Erythematosus: Prevalence and Risk Factors

To analyze the prevalence of peripheral arterial disease (PAD) and cardiovascular (CV) risk factors in a cohort of patients with systemic lupus erythematosus (SLE) and to identify variables potentially related to PAD. The study included 216 patients with SLE from the Lupus-Cruces prospective observational cohort. The ankle brachial index (ABI) was determined in each patient, with values < 0.9 considered diagnostic of PAD. Demographic and clinical variables, presence of traditional risk factors and CV events, cardiovascular risk calculated by Systematic Coronary Risk Evaluation (SCORE), and treatments received by each patient were analyzed. Ninety-two percent of patients were women. The mean age (SD) was 49 years (15), with a mean followup (SD) of 12 years (9). The prevalence of low ABI was 21%. CV risk factors were frequent: smoking, 30% of patients; high blood pressure, 32.7%; diabetes mellitus, 3.2%; hypercholesterolemia, 34.1%; and metabolic syndrome, 9.7%. The following variables were associated with low ABI in the univariate analysis: age (p < 0.001), hypertension (p = 0.002), diabetes (p = 0.018), hypercholesterolemia (p = 0.018), CV events (p < 0.001), SCORE (p = 0.004), cumulative dose of cyclophosphamide (p = 0.03), and fibrinogen levels (p = 0.002). In the multivariate analysis, the only independent variable in the final model was age (OR 1.04, 95% CI 1.02-1.07, p < 0.001), with a tendency for the presence of any vascular risk factor (diabetes, hypertension, hypercholesterolemia, or current smoking; OR 2.3, 95% CI 0.99-5.1, p = 0.053). The prevalence of low ABI in patients with SLE is higher than expected. While the association with CV risk factors and vascular disease in other territories was strong, we could not identify SLE-specific variables independently associated with PAD.

Prevalence of Low Ankle Brachial Index and Relationship With Cardiovascular Risk Factors in a Western Urban Population in Turkey

We determined the prevalence of peripheral arterial disease (PAD) and associated risk factors in an urban population age ≥30 years in Turkey and assessed the impact of incorporating ankle brachial index (ABI) measurement with coronary heart disease risk calculations to the risk reclassification of individuals. The sample was drawn from 4600 participants of Balcova Heart Study. The prevalence of low ABI (<0.9) was 6.3%. Current smoking (odds ratio [OR]: 5.07, 95% confidence interval [CI]: 1.85-13.88), cardiovascular disease history (OR: 6.83, 95% CI: 3.00-15.53), hypertension (OR: 2.58, 95% CI: 1.06-6.33), diabetes (OR: 3.25, 95% CI: 1.51-6.98), and high waist circumference (OR: 2.24, 95% CI: 1.02-4.94) were positively associated with prevalent PAD. When ABI measurement was taken into account, 3.5% of low or intermediate risk patients were reclassified as high risk. Screening individuals who have one of these risk factors with ABI can help reclassifying individuals toward the high-risk category.

High prevalence of peripheral arterial disease in hypertensive patients

Peripheral arterial disease (PAD) can be diagnosed in asymptomatic stage, measuring ankle-brachial index (ABI). Low ABI is an indicator of increased cardiovascular risk and its inclusion to traditional risk factors can improve risk prediction. The objective of the present cross-sectional part of our large-scale, multicenter, observational study was to evaluate the prevalence of PAD in a large cohort of hypertensive patients. A total of 21 892 hypertensive men and women (9162 men; mean age 61.45 years) were included in our prospective study in hypertension clinics. Clinical history, physical examination, and blood analysis were taken, and the ABI was measured with the Doppler method in all patients. The prevalence of PAD (ABI ≤ 0.9) was 14.4%. In 15.6% of the patients an ABI of 0.91-0.99, and in 9.4% of the patients high ABI (>1.3) was measured. In the low, moderate, high, and very high Systematic Coronary Risk Evaluation risk groups, the prevalence of low ABI was 8.1, 11.1, 16.3, and 26%, respectively. The prevalence of PAD was lower in hypertensive patients achieving their blood pressure target (9.6 vs. 16.8%; P < 0.001). Asymptomatic PAD was highly prevalent in the studied hypertensive population. The use of ABI screening may improve cardiovascular risk prediction. Optimal blood pressure goal values in PAD patients and cardiovascular morbidity/mortality data will be evaluated after the 5-year long prospective phase of the Evaluation of Ankle-Brachial Index in Hungarian Hypertensives program.

Abstract P309: Prevalence of Low Ankle-Brachial Index among Individuals with Non-High Risk for Coronary Heart Disease: Data from the National Health and Nutrition Examination Survey 1999–2004

Background: Abnormal ankle-brachial index (ABI) is prospectively associated with coronary heart disease (CHD) independent of traditional Framingham risk scores (FRS) variables. Two-thirds of CHD events occur in individuals with lower FRS (&lt;20%). Evaluating the role of supplemental risk assessment with ABI among those subjects may have significant public health impact. We explore prevalence of abnormal ABI among the low-intermediate risk US population according to sex, age and race. Methods: We included 5035 cardiovascular disease-free, nonpregnant, nondiabetic individuals aged from 40 to 79 years from the National Health and Nutrition Examination Survey 1999–2004, representing approximately 75 million US adults. FRS was used to estimate participants’ 10-year risk for CHD, and two risk categories were defined as low (&gt; 6%) and intermediate (6% – &lt; 20%). Individuals with risk estimates ≥ 20% were excluded from this analysis. Abnormal ABI was defined as ABI &lt; 0.9. Participants were categorized into younger ages (40–64) and older ages (65–79). The number needed to screen (NNS), which is the number of people within each stratum that needed to be screened to detect one person with abnormal ABI was used to assess the yield of screening for ABI. Results: Mean age was 53.1 years, with 45% (2261/5035) male, 19% (978/5035) non-Hispanic Black. Weighted prevalence of an abnormal ABI was 1.63% (61/2261) in men and 3.78% (138/2774) in women, corresponding to 2.1 million US adults aged 40 and above. Abnormal ABI was observed in 0.4% (2/714) and 2.4% (59/1488) in men (NNS=357 and 26) of those with low and intermediate risk, and 2.8% (85/2248) and 9.4% (53/526) in women (NNS=26 and 10), respectively. Older participants have higher prevalence of abnormal ABI than younger both in men (4.4% (29/435) vs. 1.8% (32/1826), NNS=15 and 57) and women (7.5% (63/748) vs. 2.9% (75/2026), NNS=12 and 27). Non-Hispanic Blacks have higher prevalence of abnormal ABI than other races in men (Black: 3.1% (21/458) vs. White: 1.6% (29/1144) and others: 0.9% (11/659)) as well as in women (Black: 7.1% (40/520) vs. White: 3.7% (64/1379) and others: 2.3% (34/875)). Conclusions: Among individuals at low-intermediate predicted 10-year CHD risk in US population, we observed concordance between abnormal ABI prevalence and FRS risk strata. The yield of screening and possibility of identifying abnormal ABI cases is highest in those with intermediate risk, especially older ages, non-Hispanic blacks and females.

Cardiovascular Risk Factors and Distributions of the Ankle-Brachial Index among Type 2 Diabetes Mellitus Patients

Background. The aim of present study is to observe the association between the levels of ankle-brachial index (ABI) and cardiovascular risk factors among people with type 2 diabetes mellitus in north India. A cross-sectional study was carried out at a centre for heart and diabetic clinic in the state of Punjab on 1121 subjects (671 males and 450 females) with type 2 diabetes mellitus. History of symptoms related to cardiovascular diseases was noted, and blood pressure and anthropometric measurements were recorded. Ankle-brachial index (ABI) was measured using ultrasonic Doppler flow detector. Subjects with ABI ≤0.9 and ≥1.30 were classified as having low and high ABI, respectively. Females had a higher BMI and brachial-ankle pulse wave velocity (P < 0.001). Whereas, males had higher diastolic blood pressure and duration of type 2 diabetes mellitus. The differences of systolic blood pressure and ankle-brachial index were not found significant between the sexes. The prevalence of low ABI (<0.9) was 4.47% in men and 4.67% in women and high ABI (≥1.30) was prevalent in 14% of men and 10.45% of women. Age, BMI, baPWV, and blood pressures were significantly associated with ABI value in both sexes. The results suggested that the ABI might be used as a strong indicator for cardiovascular risk factors in type 2 diabetic subjects.

Prevalence of Low Ankle Brachial Index and Its Association With Pulse Pressure in an Elderly Chinese Population: A Cross-Sectional Study

BackgroundWe investigated the prevalence of low ankle brachial index (ABI) and the association of low ABI with pulse pressure among elderly community residents in China.MethodsThis population-based cross-sectional study was conducted in Beijing and recruited 2982 participants who were aged 60 years or older in 2007. Low ABI was defined as an ABI value less than 0.9 in either leg. Participants with or without stroke or coronary heart disease (CHD) were analyzed separately. The association between pulse pressure and low ABI was examined by using multiple logistic regression models.ResultsThe prevalence of low ABI was 5.65% (4.24% among men and 6.52% among women; P = 0.0221) among participants without stroke or CHD and 10.91% (13.07% among men and 9.49% among women; P = 0.1328) among those with stroke or CHD. After adjusting for confounders, the odds ratio (95% CI) for each 5-mm Hg increase in pulse pressure was 1.19 (1.07, 1.33) and 1.10 (1.02, 1.20) for men and women, respectively, among participants without stroke or CHD and 1.17 (1.03, 1.34) and 1.15 (1.02, 1.30) for men and women with stroke or CHD. When pulse pressure was classified into quartiles and the lowest quartile was used as reference, the association between pulse pressure and low ABI remained positive in men and women.ConclusionsLow ABI was prevalent among elderly Chinese, and pulse pressure was positively associated with low ABI.

Prevalence and risk factors of abnormal ankle-brachial index in patients with type 2 diabetes

Objective To examine the prevalence of normal,low and high ankle-brachial index(ABI) in patients with type 2 diabetes and the relative risk factors.Methods A total of 3924 patients,who underwent ABI examination in our center between September 2003 and June 2010,were enrolled.Their medical profiles and laboratory data were analyzed retrospectively.The risk factors for abnormal ABI were determined using univariate and stepwise Logistic regression analysis.Results ABI was normal in 3653 patients(93.1%),0.9 in 206 patients(5.2%),and≥1.3 in 65 patients(1.7%).Elderly patients(≥65 years) had a higher prevalence of low ABI than non-elderly patients(65years)((12.2%vs 3.6%).Using normal ABI as referent,low ABI in non-elderly patients was independently associated with HbA1c,urine albumin to creatinine ratio,diabetic peripheral neuropathy,diabetic retinopathy and cerebral vascular disease.Low ABI in elderly patients was independently associated with age,smoking,HbA1c,uric acid,total cholesterol,diabetic peripheral neuropathy,diabetic retinopathy,diabetic nephropathy and cerebral vascular disease.High ABI in non-elderly patients was associated with male gender. Conclusions The prevalence of abnormal ABI is high in patients with type 2 diabetes,especially in elderly patients.Early identification and intensive treatment are strongly recommended to improve the patients' life quality and overall prognosis.

The PANDORA study: peripheral arterial disease in patients with non-high cardiovascular risk

Few studies are available with sufficient sample size to accurately describe the prevalence of low ankle-brachial index (ABI) in patients at 'non-high' cardiovascular (CV) risk. The aim of this study was to evaluate the prevalence of asymptomatic peripheral arterial disease (PAD), as determined by using ABI, in this patient population. A non-interventional, cross-sectional, pan-European study was conducted in patients with ≥1 CV risk factor in addition to age, evaluating the prevalence of asymptomatic PAD (ABI ≤ 0.90). Secondary objectives included assessing the prevalence and treatment of CV risk factors. Patients were consecutively recruited during scheduled visits to the physician's office, or were randomly selected by the physician from a list of eligible patients. Patients with diabetes were excluded as this condition was deemed to be a secondary prevention risk. 10,287 patients were enrolled (9,816 evaluable: mean age 64.3 years; 53.5% male). Prevalence of asymptomatic PAD was 17.8% (99% CI 16.84-18.83). Factors significantly associated with asymptomatic PAD included hypertension, age, alcohol intake, family history of coronary heart disease, low levels of high-density lipoprotein-cholesterol, and smoking (p < 0.0001). Patients treated with statins were significantly less likely to have asymptomatic PAD than those who were not (odds ratio 0.62; 95% CI 0.50-0.76; p < 0.0001). Asymptomatic PAD was highly prevalent in patients with non-high CV risk, the majority of whom would not typically be candidates for ABI assessment. These patients should be carefully screened, and ABI measured, so that therapeutic interventions known to diminish their increased CV risk may be offered.

Peripheral artery disease assessed by ankle-brachial index in patients with established cardiovascular disease or at least one risk factor for atherothrombosis - CAREFUL Study: A national, multi-center, cross-sectional observational study

BackgroundTo investigate the presence of peripheral artery disease (PAD) via the ankle brachial index (ABI) in patients with known cardiovascular and/or cerebrovascular diseases or with at least one risk factor for atherothrombosis.MethodsPatients with a history of atherothrombotic events, or aged 50-69 years with at least one cardiovascular risk factor, or > = 70 years of age were included in this multicenter, cross-sectional, non-interventional study (DIREGL04074). Demographics, medical history, physical examination findings, and physician awareness of PAD were analyzed. The number of patients with low ABI (< = 0.90) was analyzed.ResultsA total of 530 patients (mean age, 63.4 ± 8.7 years; 50.2% female) were enrolled. Hypertension and dyslipidemia were present in 88.7% and 65.5% of patients, respectively. PAD-related symptoms were evident in about one-third of the patients, and at least one of the pedal pulses was negative in 6.5% of patients. The frequency of low ABI was 20.0% in the whole study population and 30% for patients older than 70 years. Older age, greater number of total risk factors, and presence of PAD-related physical findings were associated with increased likelihood of low ABI (p < 0.001). There was no gender difference in the prevalence of low ABI, PAD symptoms, or total number of risk factors. Exercise (33.6%) was the most common non-pharmacological option recommended by physicians, and acetylsalicylic acid (ASA) (45.4%) was the most frequently prescribed medication for PAD.ConclusionOur results indicate that advanced age, greater number of total risk factors and presence of PAD-related physical findings were associated with increased likelihood of low ABI. These findings are similar to those reported in similar studies of different populations, and document a fairly high prevalence of PAD in a Mediterranean country.

Asymptomatic peripheral artery disease in South Indian women with type 2 diabetis

Sir, Although it is well known that peripheral vascular disease is a common macrovascular complication in diabetes, the same is rather overlooked in women when compared with their male counterparts. Moreover, asymptomatic peripheral artery disease is also not well studied, both in men and women. Asymptomatic Peripheral Arterial Disease (PAD) is defined as Ankle-Brachial Index (ABI)<0.9 in patients with no clinical evidence of PAD or foot ulcer.[1] ABI<0.9 has 90% sensitivity and specificity.[2,3] Low Ankle Brachial Index (ABI) is a predictor of future myocardial events, strokes, and amputations.[3,4] Although prevalence of PAD is high in diabetics, no studies have looked into the presence of asymptomatic PAD in diabetic women from southern India. We selected 100 type-2 diabetic women attending medical outpatient department in a rural tertiary care center (Sree Mookambika Institute of Medical Sciences, Kulasekharam, Tamil Nadu, India). Those with pre-existing PAD, with symptoms suggesting PAD-like claudication, with established coronary artery disease, and smokers or tobacco chewers were excluded. All patients were already on treatment with oral anti-diabetic drugs with fair control. Patients taking insulin regimes were excluded for uniformity. Ankle Brachial Index (ABI) was measured using blood pressure apparatus and handheld Doppler equipment. Blood sugar and Hemoglobin A1c (HbA1c) were measured to assess diabetic control of the patients. A total of 100 non-diabetic women attending general medical OP for other complaints were selected as control. Those with hypertension and metabolic syndrome were not excluded. Those with known coronary artery disease or cerebrovascular disease were not included in the control group. Those with peripheral vascular disease and symptoms suggesting PAD were excluded. Tobacco users were also excluded from the study. All 100 patients were diabetics, with more than one-year history of detected type-2 diabetes mellitus. Of the 200 people for whom ABI was measured, 22 (11%) had values less than 0.9. The prevalence of low ABI was significantly higher in diabetics –19% vs 3%. According to the data we collected, this is the first study to look into the association of asymptomatic PAD in diabetics without clinical cardiovascular disease or cerebrovascular disease in South Indian women. Most of the previous studies were done on symptomatic patients. Classical risk factors are frequently associated with low ABI.[5] A number of conditions associated with diabetes such as low High-Density Lipoprotein (HDL), high triglyceride, high Low-Density Lipoprotein (LDL), metabolic syndrome, and others, are associated with high incidence of low ABI and PAD. Although ABI may establish the diagnosis of asymptomatic PAD, the guidelines for treatment of such patients is lacking. Hence, we believe that more studies need to be conducted in this field and criteria developed, in order to ensure screening and treatment of these patients.

Prevalence of low ankle-brachial index, elevated plasma fibrinogen and CRP across Framingham risk categories: Data from the National Health and Nutrition Examination Survey (NHANES) 1999–2004

Objective60–80% of heart attacks or coronary-related deaths occur in individuals identified as non-high-risk per the conventional risk assessment algorithms. Abnormal ankle-brachial index (ABI), plasma fibrinogen and plasma C-reactive protein (CRP) have been shown to be associated with a higher risk of cardiovascular disease (CVD). However, comparable data have not been reported for prevalence of abnormal ABI, fibrinogen and CRP in non-high-risk population. MethodsWe analyzed data from the 1999–2004 National Health and Nutrition Examination Survey (NHANES), a nationally representative cross-sectional survey of the U.S. population, for 6292 men and women, aged 40 and older, without known CVD or diabetes, with available data on standard CVD risk factors, ABI, fibrinogen and CRP. The main objective was to identify proportions of individuals with abnormal ABI (ABI<0.9 in either leg), elevated fibrinogen (≥400mg/dl), and elevated CRP (>3mg/l), with otherwise low or intermediate (<20%) 10-year Framingham risk score. ResultsOverall prevalence of abnormal ABI, fibrinogen, and CRP was 3.6% (95% CI 3.2–4.1%), 27.4% (95% CI 23.9–31.0%) and 38.3% (95% CI 36.5–40.0%) respectively. Among those with ABI data, 91.4% were at <20% FRS, and of these only 2.7% (95% CI 2.3–3.1%, p<0.0001) had an abnormal ABI. Among those with fibrinogen data, 90.8% were at <20% FRS, and of these 23.6% (95% CI 20.4–26.8%, p<0.001) had elevated plasma fibrinogen. Among those with CRP data, 91.1% were at <20% FRS, and of these 34.3% (95% CI 32.7–36.0%, p=0.0012) had an elevated CRP. Overall, 45.0% (95% CI 42.2–47.8%; p<0.0001) had abnormal ABI, fibrinogen or CRP but low-intermediate risk. ConclusionAbnormal ABI, elevate fibrinogen and CRP are highly prevalent among individuals otherwise at low-intermediate risk. If any or all of them are shown to improve predictive ability of FRS for primary prevention, it would have a significant public health impact.

Prevalence of abnormal ankle brachial index in patients with primary Sjogren’s syndrome

Chronic inflammatory autoimmune conditions like rheumatoid arthritis and systemic lupus erythematosus are associated with an increased risk of accelerated atherosclerosis (ATS). Very limited data are available about the incidence of ATS in patients with primary Sjogren's syndrome (PSS). Ankle brachial index (ABI) is a recognized method of detecting subclinical atherosclerosis. The objective of this study was to compare the prevalence of abnormal ABI in patients with PSS and in controls without PSS. Twenty-five PSS patients were compared with an age-, ethnicity-, and sex-matched control group. Traditional risk factors such as smoking, high blood pressure, blood sugar, lipids, and family history of atherosclerosis were assessed in both groups. Baseline clinical and laboratory features of PSS patients were recorded. ABI was measured in both groups. ABI less than 1.0 is considered abnormal. Fifty individuals (25 in each group) were studied. PSS patients and controls did not differ significantly in age, sex, and ethnicity. The prevalence of traditional cardiovascular risk factors was the same in both groups. Five out of 25 PSS patients (20%) had an ABI < 1.0 compared to one of 25 (4%) in the control group [P = 0.189 (odds ratio (OR) = 6.000 and 95% confidence interval (CI) 0.6464 to 55.692)]. Eight out of 25 PSS patients (32%) had disease duration of more than 10 years. This group of patients had a higher prevalence of low ABI compared to the individuals with lesser disease duration [P = 0.02 (OR = 16, 95% CI 1.38 to 185)]. PSS patients had a higher prevalence of low ABI, although this did not reach statistical significance. The subgroup of PSS patients with a longer duration of disease had a significantly lower ABI. This study was underpowered and a larger study is required to confirm the findings of this pilot study.

Abstract No. 146: Prevalence of Low Ankle-Brachial Index, Elevated Plasma Fibrinogen and CRP Among Those Otherwise at Low-Intermediate Cardiovascular Events' Risk: Data from the National Health and Nutrition Examination Survey (NHANES) 1999-2004

Approximately 25% of heart attacks or sudden cardiac deaths occur in individuals NOT at high risk of such events according to conventional risk factor-based assessment. A low ankle-brachial index (ABI), elevated plasma fibrinogen and C-reactive protein (CRP) have been shown to be associated with a higher risk of cardiovascular disease (CVD). However, comparable data have not been reported for prevalence of abnormal ABI, fibrinogen and CRP among those not considered at high risk for CV events.