Félix-Redondo Francisco J, Subirana Isaac, Baena-Diez José Miguel, Ramos Rafel, Cancho Bárbara, Fernández-Bergés Daniel, Robles Nicolás Roberto
C.S. Villanueva Norte, Servicio Extremeño de Salud. Villanueva de la Serena, Badajoz, España; Unidad de Investigación, Área de Salud Don Benito - Villanueva de la Serena, Servicio Extremeño de Salud, Fundesalud, Villanueva de la Serena, Badajoz, España.
Grupo de Investigación de Epidemiologia Cardiovascular y Genética, IMIM, Barcelona, España.
Aten Primaria. 2020 Nov;52(9):627-636. doi: 10.1016/j.aprim.2020.03.005. Epub 2020 Jun 3.
The objectives have been to determine the prognostic value of having a low ankle-brachial index (ABI) for different cardiovascular diseases and whether it improves the predictive capacity of the main cardiovascular risk scores proposed for Spain.
Population-based cohort study LOCATION: A health area of the province of Badajoz (Spain) PARTICIPANTS: 2,833 subjects, representative of residents, between 25 and 79 years old, MEASUREMENTS: The ABI was measured at baseline and the first episode of ischemic heart disease or stroke, cardiovascular and total mortality, was recorded during 7 years of follow-up. The hazard ratio (HR) adjusted for cardiovascular risk factors and net reclassification index (NRI) by category, clinical and continuous for the risk functions REGICOR, FRESCO coronary heart disease, FRESCO cardiovascular disease and SCORE, were calculated.
2,665 subjects were analysed after excluding people with cardiovascular history and loss of follow-up. Low ABI was associated with adjusted HR (95% CI): 6.45 (3.00 - 13.86), 2.60 (1.15 - 5.91), 3.43 (1.39 - 8.44), 2.21 (1.27 - 3.86) for stroke, ischemic heart disease, cardiovascular mortality and total mortality respectively. The ABI improved the NRI (95% CI) in the intermediate risk category according to FRESCO cardiovascular equation by 24.1% (10.1 - 38.2).
Low ABI is associated with a significant increase in the risk of stroke, ischemic heart disease, cardiovascular mortality and total mortality in our population. The inclusion of ABI improved the reclassification of people at intermediate risk, according to FRESCO cardiovascular, so its use in that risk category would be justified.
本研究旨在确定低踝臂指数（ABI）对不同心血管疾病的预后价值，以及其是否能提高西班牙所提出的主要心血管风险评分的预测能力。
基于人群的队列研究
西班牙巴达霍斯省的一个健康区
2833名年龄在25至79岁之间的居民代表
在基线时测量ABI，并记录随访7年期间缺血性心脏病或中风的首次发作、心血管疾病和全因死亡率。计算调整心血管危险因素后的风险比（HR）以及风险函数REGICOR、FRESCO冠心病、FRESCO心血管疾病和SCORE按类别、临床和连续性划分的净重新分类指数（NRI）。
排除有心血管病史和失访的人群后，对2665名受试者进行了分析。低ABI与调整后的HR（95%CI）相关，中风为6.45（3.00 - 13.86），缺血性心脏病为2.60（1.15 - 5.91），心血管疾病死亡率为3.43（1.39 - 8.44），全因死亡率为2.21（1.27 - 3.86）。根据FRESCO心血管方程，ABI在中等风险类别中使NRI（95%CI）提高了24.1%（10.1 - 38.2）。
在我们的人群中，低ABI与中风、缺血性心脏病、心血管疾病死亡率和全因死亡率的显著增加相关。根据FRESCO心血管疾病分类，纳入ABI改善了中等风险人群的重新分类，因此在该风险类别中使用ABI是合理的。
