LOW PULSE-WAVE AMPLITUDE DURING REACTIVE LEG HYPEREMIA - AN INDEPENDENT, EARLY MARKER FOR ISCHEMIC-HEART-DISEASE AND DEATH - RESULTS FROM THE 21-YEAR FOLLOW-UP OF THE PROSPECTIVE COHORT STUDY, MEN-BORN-IN-1914, MALMO, SWEDEN

Objective. To study the incidence of myocardial infarction, all-cause mortality and mortality from ischaemic heart disease in relation to arterial leg blood flow determined by venous occlusion plethysmography of the calf. Design. A prospective cohort study 'Men born in 1914'. Setting, Malmo, a city in southern Sweden with 256 000 inhabitants, and a single referral hospital. Subjects. Six-hundred and thirty-six 55-year-old men, randomly selected from the general population.None of them had signs or symptoms of leg artery disease. Main outcome measures. All-cause mortality, morbidity and mortality from ischaemic heart disease during 21 years of follow-up following the initial examination in 1968. Results. A low pulse-wave amplitude (i.e. < 5 mm) during reactive hyperaemia was, independently of other known arteriosclerotic risk factors, associated with a higher cardiac event rate of 37.1% (relative risk: 2.2; 95% CI: 1.3-3.6) and a higher all-cause mortality rate of 62.9% (relative risk: 1.7; 95% CI: 1.2-2.4) during 21 years of follow-up. No other plethysmographically recorded variable was associated with an increased mortality and cardiac event rate. Conclusions. The plethysmographically recorded pulse-wave amplitude during reactive hyperaemia can be used as an early independent marker to identify individuals at risk of developing ischaemic heart disease and death at an early age.