The association of the ankle-brachial index with incident coronary heart disease: The Atherosclerosis Risk In Communities (ARIC) study, 1987-2001

被引：94

作者：

Weatherley B.D. ^{[1
]}

Nelson J.J. ^{[2
]}

Heiss G. ^{[3
]}

Chambless L.E. ^{[4
]}

Richey A.R. ^{[5
]}

Javier F.J. ^{[6
]}

Folsom A.R. ^{[7
]}

Rosamond W.D. ^{[3
]}

机构：

[1] Duke Clinical Research Institute, Duke University Medical Center, Durham, NC 27715

[2] Worldwide Epidemiology, GlaxoSmithKline, Durham, NC, Five Moore Drive

[3] Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill, NC

[4] Department of Biostatistics, School of Public Health, University of North Carolina, Chapel Hill, NC

[5] Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD

[6] Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI 53726

[7] Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN

来源：

BMC Cardiovascular Disorders | / 7卷 / 1期

关键词：

Coronary Heart Disease; Peripheral Arterial Disease; Coronary Heart Disease Risk; Coronary Heart Disease Event; Incident Coronary Heart Disease;

D O I：

10.1186/1471-2261-7-3

中图分类号：

学科分类号：

摘要：

Background: Peripheral arterial disease (PAD), defined by a low ankle-brachial index (ABI), is associated with an increased risk of cardiovascular events, but the risk of coronary heart disease (CHD) over the range of the ABI is not well characterized, nor described for African Americans. Methods: The ABI was measured in 12186 white and African American men and women in the Atherosclerosis Risk in Communities Study in 1987-89. Fatal and non-fatal CHD events were ascertained through annual telephone contacts, surveys of hospital discharge lists and death certificate data, and clinical examinations, including electrocardiograms, every 3 years. Participants were followed for a median of 13.1 years. Age- and field-center-adjusted hazard ratios (HRs) were estimated using Cox regression models. Results: Over a median 13.1 years follow-up, 964 fatal or non-fatal CHD events accrued. In whites, the age- and field-center-adjusted CHD hazard ratio (HR, 95% CI) for PAD (ABI<0.90) was 2.81 (1.77-4.45) for men and 2.05 (1.20-3.53) for women. In African Americans, the HR for men was 4.86 (2.76-8.47) and for women was 2.34 (1.26-4.35). The CHD risk increased exponentially with decreasing ABI as a continuous function, and continued to decline at ABI values < 1.0, in all race-gender subgroups. The association between the ABI and CHD relative risk was similar for men and women in both race groups. A 0.10 lower ABI increased the CHD hazard by 25% (95% CI 17-34%) in white men, by 20% (8-33%) in white women, by 34% (19-50%) in African American men, and by 32% (17-50%) in African American women. Conclusion: African American members of the ARIC cohort had higher prevalences of PAD and greater risk of CHD associated with ABI-defined PAD than did white participants. Unlike in other cohorts, in ARIC the CHD risk failed to increase at high (<1.3) ABI values. We conclude that at this time high ABI values should not be routinely considered a marker for increased CVD risk in the general population. Further research is needed on the value of the ABI at specific cutpoints for risk stratification in the context of traditional risk factors. © 2007 Weatherley et al; licensee BioMed Central Ltd.

引用

共 55 条

[51]

McDermott M.M., Liu K., Criqui M.H., Ruth K., Goff D., Saad M.F., Wu C., Homma S., Sharrett A.R., Ankle-brachial index and subclinical cardiac and carotid disease: The multi-ethnic study of atherosclerosis, Am J Epidemiol, 162, 1, pp. 33-41, (2005)

[52]

Collins T.C., Petersen N.J., Suarez-Almazor M., Ashton C.M., The prevalence of peripheral arterial disease in a racially diverse population, Arch Intern Med, 163, 12, pp. 1469-1474, (2003)

[53]

Wang J.C., Criqui M.H., Denenberg J.O., McDermott M.M., Golomb B.A., Fronek A., Exertional leg pain in patients with and without peripheral arterial disease, Circulation, 112, pp. 3501-3508, (2005)

[54]

Fowkes F.G., Housley E., Macintyre C.C., Prescott R.J., Ruckley C.V., Variability of ankle and brachial systolic pressures in the measurement of atherosclerotic peripheral arterial disease, Journal of Epidemiology & Community Health, 42, 2, (1988)

[55]

Flegal C.M., Keyl P.M., Nieto F.J., Differential misclassification arising from nondifferential errors in exposure measurement, American Journal of Epidemiology, 134, 10, pp. 1233-1244, (1991)

← 1 2 3 4 5 6 →