Association of ankle-brachial index and plaques in the carotid and femoral arteries with cardiovascular events and total mortality in a population-based study with 13 years of follow-up

Aims Peripheral arterial occlusive disease is associated with a high risk of cardiovascular morbidity and mortality. We prospectively examined the association of the ankle-brachial index (ABI) and arterial plaques in carotid and femoral arteries with incident myocardial infarctions (MIs) and cardiovascular and total mortality in 1325 participants of the population-based MONICA Augsburg Survey 1989/90. Methods and results At baseline, 6.1% of men and 2.6% of women had an ABI <= 0.9. At least one plaque in the carotid or femoral arteries was identified in 51.8% of men and 36.3% of women. During a 13-year follow-up, 58 persons (4.4%) suffered a MI before age 75 and 189 persons (14.3%) died, 86 (6.5%) of them from cardiovascular causes. Kaplan-Meier curves confirmed both measurements as strong predictors for all three endpoints (P < 0.0001). Cox regression analysis revealed an increase of the risk for MI and cardiovascular and total mortality of 22 (P=0.012), 35, and 32% (P < 0.00001), respectively, per 0.1 unit decrease in ABI. Correction for measurement error in ABI increased these estimates. The increase in risk for MI and cardiovascular and total mortality was 52, 70, and 45%, respectively, for each increase in the number of plaque-affected arteries (P < 0.0001). Conclusion Both ABI and number of plaque-affected arteries are strong predictors for incident MI and cardiovascular and total mortality.