Velescu A, Clara A, Martí R, Ramos R, Perez-Fernandez S, Marcos L, Grau M, Degano I R, Marrugat J, Elosua R
Angiology and Vascular Surgery Department. Hospital del Mar, Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain; CIBER Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain.
Research Unit, Family Medicine, Girona, Jordi Gol Institute for Primary Care Research (IDIAP Jordi Gol), Girona, Spain.
Eur J Vasc Endovasc Surg. 2017 Sep;54(3):370-377. doi: 10.1016/j.ejvs.2017.06.002. Epub 2017 Jul 25.
The clinical significance of a high ankle brachial index (ABI) and its relationship to cardiovascular disease (CVD) and mortality is controversial. The aim of this study was to estimate the association between abnormally high ABI ≥ 1.4 and coronary heart disease (CHD), cerebrovascular disease, and all-cause mortality in a Mediterranean population without CVD.
A prospective population based cohort study of 6352 subjects was followed up for a median 6.2 years. Subjects under 35 years, with a history of CVD or an ABI < 0.9 were excluded. All CHD events (angina, myocardial infarction, coronary revascularisation), cerebrovascular events (stroke, transient ischaemic attack), and all-cause mortality were recorded.
A total of 5679 subjects fulfilled the inclusion criteria, of which 5517 (97.1%) had a normal ABI whereas 162 (2.9%) had an ABI ≥ 1.4. The profile of individuals with abnormally high ABI revealed as independent related factors age (OR = 1.0; p = .045), female sex (OR = 0.4; p < .01), diabetes (OR = 1.9; p = .02), and lower diastolic blood pressure (OR = 0.9; p < .001). During follow-up 309 (5.4%) participants presented with a CV event and 286 (5.0%) died. An ABI ≥ 1.4 was associated with a higher incidence of CV events in the univariate (HR = 1.7) but not in the multivariate survival Cox regression analysis. An ABI ≥ 1.4 was independently associated with all-cause mortality (HR = 2.0; IC 95% 1.32-2.92) and cardiovascular mortality (HR = 3.1; IC 95% 1.52-6.48).
In subjects without CVD, those with abnormally high ABI do not have a greater CV event rate than those with a normal ABI. However, there seems to be a trend towards higher mortality risk, supporting the guidelines that consider this subgroup to be a high risk population.
高踝臂指数（ABI）的临床意义及其与心血管疾病（CVD）和死亡率的关系存在争议。本研究的目的是评估异常高ABI≥1.4与无CVD的地中海人群中冠心病（CHD）、脑血管疾病及全因死亡率之间的关联。
对6352名受试者进行基于人群的前瞻性队列研究，随访时间中位数为6.2年。排除35岁以下、有CVD病史或ABI<0.9的受试者。记录所有CHD事件（心绞痛、心肌梗死、冠状动脉血运重建）、脑血管事件（中风、短暂性脑缺血发作）及全因死亡率。
共有5679名受试者符合纳入标准，其中5517名（97.1%）ABI正常，162名（2.9%）ABI≥1.4。异常高ABI个体的特征显示，独立相关因素有年龄（OR=1.0；p=0.045）、女性（OR=0.4；p<0.01）、糖尿病（OR=1.9；p=0.02）及较低舒张压（OR=0.9；p<0.001）。随访期间，309名（5.4%）参与者发生心血管事件，286名（5.0%）死亡。在单因素分析中，ABI≥1.4与心血管事件发生率较高相关（HR=1.7），但在多因素生存Cox回归分析中并非如此。ABI≥1.4与全因死亡率（HR=2.0；95%置信区间1.32-2.92）及心血管死亡率（HR=3.1；95%置信区间1.52-6.48）独立相关。
在无CVD的受试者中，ABI异常高者的心血管事件发生率并不高于ABI正常者。然而，似乎存在死亡率风险较高的趋势，这支持了将该亚组视为高危人群的指南。
