Prevalence of Symptomatic and Asymptomatic Peripheral Arterial Disease and the Value of the Ankle-brachial Index to Stratify Cardiovascular Risk

Objectives: To determine the prevalence of ankle-brachial index (ABI) < 0.9 and symptomatic peripheral arterial disease (PAD), association with cardiovascular risk factors (CVRF), and impact of adding ABI measurement to coronary heart disease (CHD) risk screening. Design: Population-based cross-sectional survey of 6262 participants aged 35-79 in Girona, Spain. Methods: Standardized measurements (CVRF, ABI, 10-year CHD risk) and history of intermittent claudication (IC), CHD, and stroke were recorded. ABI < 0.9 was considered equivalent to moderate-to-high CHD risk (>= 10%). Results: ABI < 0.9 prevalence was 4.5%. Only 0.62% presented low ABI and IC. Age, current smoker, cardiovascular disease, and uncontrolled hypertension independently associated with ABI < 0.9 in both sexes; IC was also associated in men and diabetes in women. Among participants 35-74 free of cardiovascular disease, 6.1% showed moderate-to-high 10-year CHD risk; adding ABI measurement yielded 8.7%. Conversely, the risk function identified 16.8% of these participants as having 10-year CHID risk > 10%. In participants 75-79 free of cardiovascular disease, the prevalence of ABI < 0.9 (i.e., CHD risk >= 10%) was 11.9%. Conclusions: ABI < 0.9 is relatively frequent in those 35-79, particularly over 74. However, IC and CHD risk >= 10% indicators are often missing. Adding ABI measurement to CHD-risk screening better identifies moderate-to-high cardiovascular risk patients. (C) 2009 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.