1 Division of Cardiology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
2 Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, TX, USA.
Vasc Med. 2018 Dec;23(6):534-540. doi: 10.1177/1358863X18774845. Epub 2018 Jun 4.
The ankle-brachial index (ABI) is a predictor of cardiovascular events, mortality and functional status. Some studies have noted a higher prevalence of peripheral artery disease in females compared to males. Differences in height might account for these observed sex differences, but findings are conflicting. The 2003-2004 National Health and Nutrition Examination Survey (NHANES) cohort includes participants from 15 geographic locations, selected annually to represent the general population. Sample-weighted multivariable linear and logistic regression modeling was performed with ABI as the dependent variable and height and sex as primary exposure variables of interest. There were 3052 participants with ABI data (mean age 57 years, 51% female). The mean (±SE) ABI was 1.09 (±0.006) and 1.13 (±0.005) for females and males, respectively ( p < 0.0001). Shorter height was associated with a low ABI (OR 0.91 per 4 cm, 95% CI: 0.86-0.96; p=0.001). In a fully adjusted model, female sex was associated with a low ABI (OR 1.34, 95% CI: 1.04-1.72; p=0.025) independent of height and traditional cardiovascular disease (CVD) risk factors. Age, diabetes, tobacco use, known CVD, hypertension and race were associated with a low ABI (all p < 0.001). The ABI was 0.03 lower in females than in males in the general population and in a healthy cohort. Lower ABI values in healthy females do not appear to be due to occult vascular disease but rather a normal phenomenon with some contribution from height. Therefore, population sex-specific ABI thresholds should be utilized in the diagnosis of peripheral artery disease to account for these intrinsic differences.
踝臂指数（ABI）是心血管事件、死亡率和功能状态的预测指标。一些研究表明，女性外周动脉疾病的患病率高于男性。身高的差异可能解释了这些观察到的性别差异，但研究结果存在矛盾。2003-2004 年全国健康和营养调查（NHANES）队列包括来自 15 个地理位置的参与者，这些地理位置每年都会被选中以代表一般人群。使用 ABI 作为因变量，身高和性别作为主要感兴趣的暴露变量，对样本加权多变量线性和逻辑回归模型进行了分析。共有 3052 名参与者具有 ABI 数据（平均年龄 57 岁，51%为女性）。女性和男性的平均（±SE）ABI 分别为 1.09（±0.006）和 1.13（±0.005）（p<0.0001）。身高较矮与 ABI 较低相关（OR 每 4cm 为 0.91，95%CI：0.86-0.96；p=0.001）。在完全调整的模型中，女性性别与 ABI 较低相关（OR 1.34，95%CI：1.04-1.72；p=0.025），独立于身高和传统心血管疾病（CVD）危险因素。年龄、糖尿病、吸烟、已知的 CVD、高血压和种族与 ABI 较低相关（均 p<0.001）。在一般人群和健康队列中，女性的 ABI 比男性低 0.03。健康女性的 ABI 值较低似乎不是由于隐匿性血管疾病，而是一种正常现象，与身高有一定关系。因此，在诊断外周动脉疾病时，应根据人群的性别特异性 ABI 阈值，考虑这些内在差异。
