Leng G C, Fowkes F G, Lee A J, Dunbar J, Housley E, Ruckley C V
Wolfson Unit for Prevention of Peripheral Vascular Diseases, Department of Public Health Sciences, University of Edinburgh.
BMJ. 1996 Dec 7;313(7070):1440-4. doi: 10.1136/bmj.313.7070.1440.
To determine whether a low ankle brachial pressure index is associated with an increased risk of cardiovascular events and death, and whether the prediction of such events could be improved by including this index.
Cohort study.
11 practices in Edinburgh, Scotland.
1592 men and women aged 55-74 years selected at random from the age-sex registers of 11 general practices and followed up for 5 years.
Incidence of fatal and non-fatal cardiovascular events and all cause mortality.
At baseline 90 (5.7%) of subjects had an ankle brachial pressure index < or = 0.7, 288 (18.2%) had an index < or = 0.9, and 566 (35.6%) < or = 1.0. After five years subjects with an index < or = 0.9 at baseline had an increased risk of non-fatal myocardial infarction (relative risk 1.38, 95% confidence interval 0.88 to 2.16), stroke (1.98, 1.05 to 3.77), cardiovascular death (1.85, 1.15 to 2.97), and all cause mortality (1.58, 1.14 to 2.18) after adjustment for age, sex, coronary disease, and diabetes at baseline. The ability to predict subsequent events was greatly increased by combining the index with other risk factors--for example, hypertensive smokers with normal cholesterol concentrations had a positive predictive value of 25.0%, increasing to 43.8% in subjects with a low index and decreasing to 15.6% in those with a normal index.
The ankle brachial pressure index is a good predictor of subsequent cardiovascular events, and improves on predictions by conventional risk factors alone. It is simple and accurate and could be included in routine screening of cardiovascular status.
确定低踝臂压力指数是否与心血管事件和死亡风险增加相关，以及纳入该指数是否能改善对此类事件的预测。
队列研究。
苏格兰爱丁堡的11家医疗机构。
从11家全科诊所的年龄 - 性别登记册中随机选取的1592名年龄在55 - 74岁之间的男性和女性，随访5年。
致命和非致命心血管事件的发生率以及全因死亡率。
在基线时，90名（5.7%）受试者的踝臂压力指数≤0.7，288名（18.2%）指数≤0.9，566名（35.6%）≤1.0。五年后，在对基线时的年龄、性别、冠心病和糖尿病进行调整后，基线时指数≤0.9的受试者发生非致命心肌梗死（相对风险1.38，95%置信区间0.88至2.16）、中风（1.98，1.05至3.77）、心血管死亡（1.85，1.15至2.97）和全因死亡率（1.58，1.14至2.18）的风险增加。将该指数与其他风险因素相结合，预测后续事件的能力大幅提高——例如，胆固醇浓度正常的高血压吸烟者的阳性预测值为25.0%，指数低的受试者中该值增至43.8%，指数正常的受试者中则降至15.6%。
踝臂压力指数是后续心血管事件的良好预测指标，且比仅用传统风险因素进行预测有所改善。它简单准确，可纳入心血管状态的常规筛查。
