Matsushita Kunihiro, Ballew Shoshana H, Sang Yingying, Kalbaugh Corey, Loehr Laura R, Hirsch Alan T, Tanaka Hirofumi, Heiss Gerardo, Windham B Gwen, Selvin Elizabeth, Coresh Josef
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Atherosclerosis. 2017 Feb;257:208-215. doi: 10.1016/j.atherosclerosis.2016.11.023. Epub 2016 Nov 23.
Most prior studies investigating the association of lower extremity peripheral artery disease (PAD) with physical function were small or analyzed selected populations (e.g., patients at vascular clinics or persons with reduced function), leaving particular uncertainty regarding the association in the general community.
Among 5262 ARIC participants (age 71-90 years during 2011-2013), we assessed the cross-sectional association of ankle-brachial index (ABI) with the Short Physical Performance Battery (SPPB) score (0-12), its individual components (chair stands, standing balance, and gait speed) (0-4 points each), and grip strength after accounting for potential confounders, including a history of coronary disease, stroke, or heart failure.
There were 411 participants (7.8%) with low ABI ≤0.90 and 469 (8.9%) participants with borderline low ABI 0.91-1.00. Both ABI ≤0.90 and 0.91-1.00 were independently associated with poor physical function (SPPB score ≤6) compared to ABI 1.11-1.20 (adjusted odds ratio 2.10 [95% CI 1.55-2.84] and 1.86 [1.38-2.51], respectively). The patterns were largely consistent across subgroups by clinical conditions (e.g., leg pain or other cardiovascular diseases), in every SPPB component, and for grip strength. ABI >1.3 (472 participants [9.0%]), indicative of non-compressible pedal arteries, was related to lower physical function as well but did not necessarily reach significance.
In community-dwelling older adults, low and borderline low ABI suggestive of PAD were independently associated with poorer systemic physical function compared to those with normal ABI. Clinical attention to PAD as a potential contributor to poor physical function is warranted in community-dwelling older adults.
既往大多数研究下肢外周动脉疾病（PAD）与身体功能之间关联的研究规模较小，或分析的是特定人群（如血管诊所的患者或功能减退者），这使得普通人群中二者的关联存在特别的不确定性。
在5262名动脉粥样硬化风险社区研究（ARIC）参与者中（2011 - 2013年期间年龄为71 - 90岁），我们评估了踝臂指数（ABI）与简短体能状况量表（SPPB）评分（0 - 12分）、其各个组成部分（从椅子上站起、站立平衡和步速）（每项0 - 4分）以及握力之间的横断面关联，同时考虑了潜在的混杂因素，包括冠心病、中风或心力衰竭病史。
有411名参与者（7.8%）ABI较低（≤0.90），469名参与者（8.9%）ABI临界低（0.91 - 1.00）。与ABI为1.11 - 1.20相比，ABI≤0.90和0.91 - 1.00均与身体功能差（SPPB评分≤6）独立相关（调整后的优势比分别为2.10 [95%置信区间1.55 - 2.84]和1.86 [1.38 - 2.51]）。在按临床状况（如腿痛或其他心血管疾病）划分的亚组中，在每个SPPB组成部分以及握力方面，这种模式基本一致。ABI>1.3（472名参与者[9.0%]），表明足部动脉不可压缩，也与较低的身体功能有关，但不一定具有统计学意义。
在社区居住的老年人中，提示PAD的低ABI和临界低ABI与正常ABI者相比，独立地与较差的全身身体功能相关。对于社区居住的老年人，应临床关注PAD作为身体功能差的一个潜在因素。
