Low, borderline and normal ankle-brachial index as a predictor of incidents outcomes in the Mediterranean based-population ARTPER cohort after 9 years follow-up

M Teresa Alzamora; Rosa Forés; Guillem Pera; José Miguel Baena-Díez; Marta Valverde; Pere Torán

doi:10.1371/journal.pone.0209163

Low, borderline and normal ankle-brachial index as a predictor of incidents outcomes in the Mediterranean based-population ARTPER cohort after 9 years follow-up

PLoS One. 2019 Jan 23;14(1):e0209163. doi: 10.1371/journal.pone.0209163. eCollection 2019.

Authors

M Teresa Alzamora^{1

2}, Rosa Forés^{1

2

3}, Guillem Pera², José Miguel Baena-Díez^{4

5}, Marta Valverde^{5

6}, Pere Torán²

Affiliations

¹ Centre d'Atenció Primària Riu Nord- Riu Sud Santa Coloma de Gramenet, Direcció d'Atenció Primària Barcelonés Nord i Maresme, Institut Català de la Salut, Barcelona, Spain.
² Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Spain.
³ Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain.
⁴ Centre d'Atenció Primària La Marina, Direcció d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain.
⁵ Unitat de Suport a la Recerca Barcelona, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.
⁶ Hospital Nostra Senyora de Meritxell, Escaldes-Engordany, Andorra.

Abstract

Background: Guidelines recommended adopting the same cardiovascular risk modification strategies used for coronary disease in case of low Ankle-brachial index (ABI), but here exist few studies on long-term cardiovascular outcomes in patients with borderline ABI and even fewer on the general population.

Aim: The aim of the present study was to analyze the relationship between long-term cardiovascular events and low, borderline and normal ABI after a 9-year follow up of a Mediterranean population with low cardiovascular risk.

Design and setting: A population-based prospective cohort study was performed in the province of Barcelona, Spain.

Method: A total of 3,786 subjects >49 years were recruited from 2006-2008. Baseline ABI was 1.08 ± 0.16. Subjects were followed from the time of enrollment to the end of follow-up in 2016 via phone calls every 6 months, systematic reviews of primary-care and hospital medical records and analysis of the SIDIAP (Information System for Primary Care Research) database to confirm the possible appearance of cardiovascular events.

Results: 3146 individuals participated in the study. 2,420 (77%) subjects had normal ABI, 524 (17%) had borderline ABI, and 202 (6.4%) had low ABI. In comparison with normal and borderline subjects, patients with lower ABI had more comorbidities, such as hypertension, hypercholesterolemia and diabetes. Cumulative MACE incidence at 9 years was 20% in patients with low ABI, 6% in borderline ABI and 5% in normal ABI. The annual MACE incidence after 9 years follow-up was significantly higher in people with low ABI (26.9/1000py) (p<0.001) than in borderline (6.6/1000py) and in normal ABI (5.6/1000py). Subjects with borderline ABI are at significantly higher risk for coronary disease (HR: 1.58; 95% CI: 1.02-2, 43; p = 0,040) compared to subjects with normal ABI, after adjustment.

Conclusion: The results of the present study support that low ABI was independently associated with higher incidence of MACE, ICE, cardiovascular and no cardiovascular mortality; while borderline ABI had significantly moderate risk for coronary disease than normal ABI.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Ankle Brachial Index*
Cohort Studies
Coronary Disease / epidemiology*
Follow-Up Studies
Humans
Incidence
Prospective Studies
Risk Factors

Grants and funding

Funding was provided by Instituto de Salud Carlos III (PI15/00510, PI11/00765, PI07/90415) to MTA. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.