Del Brutto Oscar H, Sedler Mark J, Mera Robertino M, Lama Julio, Gruen Jadry A, Phelan Kelsie J, Cusick Elizabeth H, Zambrano Mauricio, Brown David L
School of Medicine, Universidad Espíritu Santo, Guayaquil, Ecuador.
School of Medicine, Stony Brook University, New York, NY, USA.
Int J Stroke. 2015 Jun;10(4):589-93. doi: 10.1111/ijs.12450. Epub 2015 Jan 12.
An abnormal ankle-brachial index has been associated with overt stroke and coronary heart disease, but little is known about its relationship with silent cerebral small vessel disease.
To assess the value of ankle-brachial index as a predictor of silent small vessel disease in an Ecuadorian geriatric population.
Stroke-free Atahualpa residents aged ≥60 years were identified during a door-to-door survey. Ankle-brachial index determinations and brain magnetic resonance imaging were performed in consented persons. Ankle-brachial index ≤0.9 and ≥1.4 were proxies of peripheral artery disease and noncompressible arteries, respectively. Using logistic regression models adjusted for age, gender, and cardiovascular health status, we evaluated the association between abnormal ankle-brachial index with silent lacunar infarcts, white matter hyperintensities, and cerebral microbleeds.
Mean age of the 224 participants was 70 ± 8 years, 60% were women, and 80% had poor cardiovascular health status. Ankle-brachial index was ≤0.90 in 37 persons and ≥1.4 in 17. Magnetic resonance imaging showed lacunar infarcts in 27 cases, moderate-to-severe white matter hyperintensities in 47, and cerebral microbleeds in 26. Adjusted models showed association of lacunar infarcts with ankle-brachial index ≤ 0.90 (OR: 3.72, 95% CI: 1.35-10.27, P = 0.01) and with ankle-brachial index ≥ 1.4 (OR: 3·85, 95% CI: 1.06-14.03, P = 0.04). White matter hyperintensities were associated with ankle-brachial index ≤ 0.90 (P = 0.03) and ankle-brachial index ≥ 1.4 (P = 0.02) in univariate analyses. There was no association between ankle-brachial index groups and cerebral microbleeds.
In this population-based study conducted in rural Ecuador, apparently healthy individuals aged ≥60 years with ankle-brachial index values ≤0.90 and ≥1.4 are almost four times more likely to have a silent lacunar infarct. Ankle-brachial index screening might allow recognition of asymptomatic people who need further investigation and preventive therapy.
踝臂指数异常与显性卒中及冠心病相关，但关于其与无症状性脑小血管病的关系知之甚少。
评估踝臂指数作为厄瓜多尔老年人群无症状小血管病预测指标的价值。
在挨家挨户的调查中识别出年龄≥60岁且无卒中的阿塔瓦尔帕居民。对同意参与的人员进行踝臂指数测定及脑磁共振成像检查。踝臂指数≤0.9和≥1.4分别代表外周动脉疾病和不可压缩动脉。使用经年龄、性别及心血管健康状况校正的逻辑回归模型，我们评估了异常踝臂指数与无症状腔隙性脑梗死、脑白质高信号及脑微出血之间的关联。
224名参与者的平均年龄为70±8岁，60%为女性，80%的人心血管健康状况较差。37人的踝臂指数≤0.90，17人的踝臂指数≥1.4。磁共振成像显示27例有腔隙性脑梗死，47例有中度至重度脑白质高信号，26例有脑微出血。校正模型显示，腔隙性脑梗死与踝臂指数≤0.90（比值比：3.72，95%置信区间：1.35 - 10.27，P = 0.01）及踝臂指数≥1.4（比值比：3.85，95%置信区间：1.小血管病预测指标的价值。
在挨家挨户的调查中识别出年龄≥60岁且无卒中的阿塔瓦尔帕居民。对同意参与的人员进行踝臂指数测定及脑磁共振成像检查。踝臂指数≤0.9和≥1.4分别代表外周动脉疾病和不可压缩动脉。使用经年龄、性别及心血管健康状况校正的逻辑回归模型，我们评估了异常踝臂指数与无症状腔隙性脑梗死、脑白质高信号及脑微出血之间的关联。
224名参与者的平均年龄为70±8岁，60%为女性，80%的人心血管健康状况较差。37人的踝臂指数≤0.90，17人的踝臂指数≥1.4。磁共振成像显示27例有腔隙性脑梗死，47例有中度至重度脑白质高信号，26例有脑微出血。校正模型显示，腔隙性脑梗死与踝臂指数≤0.90（比值比：3.72, 95%置信区间：1.35 - 10.27, P = 0.01）及踝臂指数≥1.4（比值比：3.85, 95%置信区间：
在这项在厄瓜多尔农村地区开展的基于人群的研究中，年龄≥60岁、踝臂指数值≤0.90和≥1.4的表面健康个体发生无症状腔隙性脑梗死的可能性几乎高出四倍。踝臂指数筛查可能有助于识别需要进一步检查和预防性治疗的无症状人群。 06 - 14.03, P = 0.04）相关。在单因素分析中，脑白质高信号与踝臂指数≤0.90（P = 0.03）及踝臂指数≥1.4（P = 0.02）相关。踝臂指数组与脑微出血之间无关联。
在这项于厄瓜多尔农村地区开展的基于人群的研究中，年龄≥60岁、踝臂指数值≤0.90和≥1.4的表面健康个体发生无症状腔隙性脑梗死的可能性几乎高出四倍。踝臂指数筛查可能有助于识别需要进一步检查和预防性治疗的无症状人群。
