Section of Vascular Medicine, Massachusetts General Hospital, Boston, MA.
Hospital Medicine Program, Beth Israel Deaconess Medical Center, Boston, MA.
J Vasc Surg. 2024 Oct;80(4):1251-1259. doi: 10.1016/j.jvs.2024.06.005. Epub 2024 Jun 10.
BACKGROUND: Only a few small studies have shown the association between high ankle-brachial pressure index (ABI >1.4) and adverse cardiovascular (CV) events and mortality. Although there is abundant literature depicting the association between ABI and overall systemic atherosclerosis, it typically focuses on low ABI. Furthermore, historically, many studies focusing on peripheral artery disease have excluded high ABI participants. We aimed to study the mortality outcomes of persons with high ABI in the National Health and Nutrition Examination Survey (NHANES). METHODS: We obtained ABI from participants aged ≥40 years for survey years 1999 to 2004. We defined low a ABI as ≤0.9, normal ABI as 0.9 to 1.4, and high ABI as >1.4 or if the ankle pressures were >245 mm Hg. Demographics, various comorbidities, and laboratory test results were obtained at the time of the survey interview. Multivariable adjusted hazard ratios (HRs) along with 95% confidence intervals (CIs) were calculated for CV and all-cause mortality via Cox proportional hazards regression. Mortality was linked to all NHANES participants for follow-up through December 31, 2019, by the Centers for Disease Control and Prevention. RESULTS: We identified 7639 NHANES participants with available ABI. Of these, 6787 (89%) had a normal ABI, 646 (8%) had a low ABI, and 206 (3%) had elevated ABI. Of participants with high ABI, 50% were men, 15% were African Americans, 10% were current smokers, 56% had hypertension, 33% had diabetes, 15% had chronic kidney disease (CKD), and 18% had concomitant coronary artery disease (CAD). Diabetes (odds ratio [OR], 2.4; 95% CI, 1.7-3.2), CAD (OR, 1.6; 95% CI, 1.0-2.4), and CKD (OR, 1.5; 95% CI, 1.0-2.3) at baseline were associated with having a high ABI, respectively. A high ABI was associated independently with elevated CV (HR, 2.6; 95% CI, 2.1-3.1; P < .0001) and all-cause mortality (HR, 2.5; 95% CI, 2.2-2.8; P < .0001) after adjusting for covariates, including diabetes, CKD, CAD, current smoking, cancer, and hypertension. CONCLUSIONS: A high ABI is associated with an elevated CV and all-cause mortality, similar to patients with PAD. High ABI participants should receive the same attention and aggressive medical therapies as patients with PAD.
背景：仅有少数几项小型研究表明，高踝臂血压指数（ABI＞1.4）与不良心血管（CV）事件和死亡率之间存在关联。尽管有大量文献描述了 ABI 与全身系统性动脉粥样硬化之间的关联，但通常侧重于 ABI 较低的情况。此外，从历史上看，许多专注于外周动脉疾病的研究排除了 ABI 较高的参与者。我们旨在研究国家健康与营养检查调查（NHANES）中 ABI 较高者的死亡率结局。
方法：我们从 1999 年至 2004 年参加调查的年龄≥40 岁的参与者中获得了 ABI。我们将低 ABI 定义为≤0.9，正常 ABI 定义为 0.9 至 1.4，高 ABI 定义为＞1.4 或踝部压力＞245mmHg。在调查访谈时获得了人口统计学信息、各种合并症和实验室检查结果。通过 Cox 比例风险回归计算了 CV 和全因死亡率的多变量调整风险比（HR）及其 95%置信区间（CI）。通过疾病控制和预防中心（CDC）将所有 NHANES 参与者的随访链接到 2019 年 12 月 31 日。
结果：我们确定了 7639 名具有可用 ABI 的 NHANES 参与者。其中，6787 名（89%）的 ABI 正常，646 名（8%）的 ABI 较低，206 名（3%）的 ABI 升高。ABI 较高的参与者中，50%为男性，15%为非裔美国人，10%为当前吸烟者，56%患有高血压，33%患有糖尿病，15%患有慢性肾脏病（CKD），18%患有并存的冠状动脉疾病（CAD）。糖尿病（比值比[OR]，2.4；95%CI，1.7-3.2）、CAD（OR，1.6；95%CI，1.0-2.4）和 CKD（OR，1.5；95%CI，1.0-2.3）分别与基线时的高 ABI 相关。高 ABI 与 CV 升高（HR，2.6；95%CI，2.1-3.1；P＜0.0001）和全因死亡率（HR，2.5；95%CI，2.2-2.8；P＜0.0001）独立相关，经调整协变量后包括糖尿病、CKD、CAD、当前吸烟、癌症和高血压。
结论：高 ABI 与 CV 和全因死亡率升高有关，与患有 PAD 的患者相似。高 ABI 参与者应像患有 PAD 的患者一样受到同样的关注和积极的医疗治疗。
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