LOW ANKLE-BRACHIAL PRESSURE INDEX IN 68-YEAR-OLD MEN - PREVALENCE, RISK-FACTORS AND PROGNOSIS - RESULTS FROM PROSPECTIVE POPULATION STUDY MEN BORN IN 1914, MALMO, SWEDEN

The objectives were to study the distribution of ankle-brachial pressure indices (ABPI) in elderly men in relation to arteriosclerotic risk factors, cardiovascular morbidity and total mortality. The data are taken from the prospective cohort study "Men born in 1914" in Malmö, a city in southern Sweden with 220 000 inhabitants and a single referral hospital. Prevalence of low ABPI (<0.90) at 68 years of age, total mortality, mortality from ischaemic heart disease (IHD) International Classification of Diseases (ICD) code 410.0-412.9) and cardiac event rate [fatal and non-fatal mycocardial infarction (MI) and mortality from chronic ischaemic heart disease] during 8 years of follow-up was measured. Sixty-seven of 477 randomly selected men (14.0%) had an ABPI < 0.90 in one or both legs, 18/477 (3.8%) had intermittent claudication according to the Rose questionnaire, which had a sensitivity of 14.9% and a specificity of 98% when using ABPI as a reference method. Ninety-two per cent of the men with an ABPI < 0.90 were or had been smokers, compared with 80% of the men with an ABPI ≥ 0.90. Mean systolic blood pressure and median plasma triglyceride levels were significantly higher in the group with low ABPI. Thirty (45%) of the men with low ABPI and 87 (21%) of the men with pressure indices above 0.90 died during follow-up (p < 0.001). Cardiac event rate was 25% (17/67) in the group with low ABPI and 10% (41/410) in the other group (p < 0.001). Multivariate analysis showed that an ABPI < 0.90 independent of smoking, hypertension and hyperlipidaemia and of history of IHD is associated with an increased total mortality rate (relative risk 2.3, 95% CI 1.4-3.8) and an increased cardiac event rate (relative risk 2.3, 95% CI 1.2-4.3). We conclude that peripheral arterial disease as defined by an ABPI < 0.90 is a common finding in elderly men. Less than 20% of these men have intermittent claudication according to the Rose questionnaire. An ankle-brachial pressure index of <0.90 can be considered a simple and valid marker to identify individuals at high risk of a myocardial infarction and premature death. © 1993 Grune & Stratton Ltd.