College of Nursing, University of Arizona, Tucson, 85721-0203, USA.
Am Heart J. 2011 May;161(5):979-85. doi: 10.1016/j.ahj.2011.02.003.
Screening for peripheral arterial disease (PAD) by measuring ankle brachial index (ABI) in asymptomatic older adults is currently recommended to improve cardiovascular disease risk assessment and establish early treatment, but it is not clear if the strategy is useful in all populations. We examined the prevalence and independent predictors of an abnormal ABI (<0.90), in an asymptomatic sample of 1,017 adults, 60 to 69 years old, enrolled in the ADVANCE study.
Baseline data collected between December 2001 and January 2004 among the healthy older controls enrolled in ADVANCE was examined. Frequency distributions and prevalence estimates of an abnormal ABI were calculated, using both standard and modified definitions of ABI. Stepwise logistic regression was used to examine independent predictors of ABI <0.90. Signal detection analysis using recursive partitioning was employed to explore potential demographic and clinical variables related to ABI <0.90.
The prevalence of ABI <0.90 was 2% when using the standard definition and 5% when using a modified definition. ABI prevalence did not differ by gender (P > .05). Compared with subjects who had a normal ABI (0.90-1.39), subjects with an ABI <0.90 were more likely to currently smoke, be physically inactive, have a coronary artery calcium score >10, and an FRS >20% (P ≤ .02). Independent predictors of ABI <0.90 when using the standard definition included currently smoking, physical inactivity, and body mass index >30 (all P values ≤.03), and when using the modified definition included currently smoking, physical inactivity, and hypertension (all P values ≤.04). Currently, smoking was the only significant variable for ABI <0.90 derived through recursive partitioning (P = .02), and indicated that prevalence of ABI <0.90 was 1.5% for nonsmokers, while it was 6.6% for current smokers.
ABI screening in generally healthy individuals 60 to 69 years old may result in lower prevalence rates of a positive result than estimates based on studies in clinical populations. The modified definition for calculating ABI captured more asymptomatic adults with suspected peripheral arterial disease. More evaluation of the appropriate role of ABI screening in unselected populations is needed before routine screening is implemented.
通过测量无症状老年人群的踝臂指数（ABI）来筛查外周动脉疾病（PAD），目前被推荐用于改善心血管疾病风险评估并进行早期治疗，但尚不清楚该策略是否适用于所有人群。我们在 ADVANCE 研究中，对 1017 名年龄在 60 至 69 岁的无症状成年人进行了一项研究，以检查异常 ABI（<0.90）的患病率和独立预测因素。
我们对 ADVANCE 中纳入的健康老年人的基线数据（2001 年 12 月至 2004 年 1 月期间收集）进行了检查。使用 ABI 的标准和改良定义计算了异常 ABI 的频率分布和患病率估计值。采用逐步逻辑回归分析检查 ABI<0.90 的独立预测因素。使用递归分区进行信号检测分析，以探索与 ABI<0.90 相关的潜在人口统计学和临床变量。
使用标准定义时，ABI<0.90 的患病率为 2%，使用改良定义时，ABI<0.90 的患病率为 5%。ABI 的患病率在性别之间没有差异（P>0.05）。与 ABI 正常（0.90-1.39）的受试者相比，ABI<0.90 的受试者更有可能目前吸烟、不运动、冠状动脉钙评分>10 且 Framingham 风险评分>20%（P≤0.02）。使用标准定义时，ABI<0.90 的独立预测因素包括目前吸烟、不运动和体重指数>30（所有 P 值均≤0.03），而使用改良定义时，ABI<0.90 的独立预测因素包括目前吸烟、不运动和高血压（所有 P 值均≤0.04）。目前，吸烟是通过递归分区得出的 ABI<0.90 的唯一显著变量（P=0.02），表明不吸烟者的 ABI<0.90 的患病率为 1.5%，而吸烟者为 6.6%。
在一般健康的 60 至 69 岁人群中进行 ABI 筛查，与基于临床人群研究的估计相比，阳性结果的患病率可能较低。计算 ABI 的改良定义可捕捉到更多疑似外周动脉疾病的无症状成年人。在实施常规筛查之前，需要对未选择人群中 ABI 筛查的适当作用进行更多评估。
