Newman A B, Shemanski L, Manolio T A, Cushman M, Mittelmark M, Polak J F, Powe N R, Siscovick D
University of Pittsburgh, Pittsburgh, PA, USA. anewman+@pitt.edu
Arterioscler Thromb Vasc Biol. 1999 Mar;19(3):538-45. doi: 10.1161/01.atv.19.3.538.
Peripheral arterial disease (PAD) in the legs, measured noninvasively by the ankle-arm index (AAI) is associated with clinically manifest cardiovascular disease (CVD) and its risk factors. To determine risk of total mortality, coronary heart disease, or stroke mortality and incident versus recurrent CVD associated with a low AAI, we examined the relationship of the AAI to subsequent CVD events in 5888 older adults with and without CVD. The AAI was measured in 5888 participants >/=65 years old at the baseline examination of the Cardiovascular Health Study. All participants had a detailed assessment of prevalent CVD and were contacted every 6 months for total mortality and CVD events (including CVD mortality, fatal and nonfatal myocardial infarction, congestive heart failure, angina, stroke, and hospitalized PAD). The crude mortality rate at 6 years was highest (32.3%) in those participants with prevalent CVD and a low AAI (P<0.9), and it was lowest in those with neither of these findings (8.7%, P<0.01). Similar patterns emerged from analysis of recurrent CVD and incident CVD. The risk for incident congestive heart failure (relative risk [RR]=1.61) and for total mortality (RR=1.62) in those without CVD at baseline but with a low AAI remained significantly elevated after adjustment for cardiovascular risk factors. Hospitalized PAD events occurred months to years after the AAI was measured, with an adjusted RR of 5.55 (95% CI, 3.08 to 9.98) in those at risk for incident events. A statistically significant decline in survival was seen at each 0.1 decrement in the AAI. An AAI of <0.9 is an independent risk factor for incident CVD, recurrent CVD, and mortality in this group of older adults in the Cardiovascular Health Study.
通过踝臂指数（AAI）进行无创测量的腿部外周动脉疾病（PAD）与临床表现明显的心血管疾病（CVD）及其危险因素相关。为了确定与低AAI相关的全因死亡率、冠心病或卒中死亡率以及新发与复发CVD的风险，我们在5888名有或无CVD的老年人中研究了AAI与随后CVD事件之间的关系。在心血管健康研究的基线检查中，对5888名年龄≥65岁的参与者测量了AAI。所有参与者都对现患CVD进行了详细评估，并每6个月随访一次全因死亡率和CVD事件（包括CVD死亡率、致命和非致命性心肌梗死、充血性心力衰竭、心绞痛、卒中以及住院治疗的PAD）。在那些有现患CVD且AAI较低的参与者中，6年时的粗死亡率最高（32.3%）（P<0.9），而在既无现患CVD也无低AAI的参与者中最低（8.7%，P<0.01）。对复发CVD和新发CVD的分析也出现了类似模式。在基线时无CVD但AAI较低的参与者中，调整心血管危险因素后，新发充血性心力衰竭的风险（相对风险[RR]=1.61）和全因死亡率（RR=1.62）仍然显著升高。住院治疗的PAD事件在测量AAI数月至数年之后发生，在有新发事件风险的参与者中，调整后的RR为5.55（95%可信区间，3.08至9.98）。AAI每降低0.1，生存率就出现统计学上的显著下降。在心血管健康研究的这组老年人中，AAI<0.9是新发CVD、复发CVD和死亡率的独立危险因素。
