November 26, 2014
JACC: Heart Failure
- The authors examined the correlation between ankle–brachial index (ABI) and risk for heart failure (HF) in a large retrospective study involving 13,150 patients (free of HF at baseline) followed up over a period of 17 years. Compared with patients with an ABI of 1.01 to 1.40, those with an ABI <0.90 were at an increased risk for HF (HR, 1.40), as were those with an ABI of 0.91 to 1.00 (HR, 1.36). These values were obtained after adjusting for traditional risk factors and prevalent cardiac disease.
- The authors conclude that an ABI < 1.00 is associated with an increased risk for HF, independent of other risk factors and prevalent heart disease and recommend ABI as a risk marker for HF.
Abstract
OBJECTIVES
The aim of this study was to describe the relationship between ankle brachial index (ABI) and the risk for heart failure (HF).
BACKGROUND
The ABI is a simple, noninvasive measure associated with atherosclerotic cardiovascular disease and death; however, the relationship between ABI and risk for HF is less well characterized.
METHODS
Between 1987 and 1989 in the ARIC (Atherosclerosis Risk In Communities) study, an oscillometric device was used to measure blood pressure in a single upper and randomly chosen lower extremity to determine the ABI. Incident HF events were defined by the first hospitalization with an International Classification of Diseases, Ninth Revision, code of 428.x through 2008. The risk for HF was assessed across the ABI range using restricted cubic splines and Cox proportional hazards models.
RESULTS
ABI was available in 13,150 participants free from prevalent HF. Over a mean 17.7 years of follow-up, 1,809 incident HF events occurred. After adjustment for traditional HF risk factors, prevalent coronary heart disease, subclinical carotid atherosclerosis, and interim myocardial infarction, compared with an ABI of 1.01 to 1.40, participants with ABIs ≤0.90 were at increased risk for HF (hazard ratio: 1.40; 95% confidence interval: 1.12 to 1.74), as were participants with ABIs of 0.91 to 1.00 (hazard ratio: 1.36; 95% confidence interval: 1.17 to 1.59).
CONCLUSIONS
In a middle-age community cohort, an ABI ≤1.00 was significantly associated with an increased risk for HF, independent of traditional HF risk factors, prevalent coronary heart disease, carotid atherosclerosis, and interim myocardial infarction. Low ABI may reflect not only overt atherosclerosis but also pathologic processes in the development of HF beyond epicardial atherosclerotic disease and myocardial infarction alone. A low ABI, as a simple, noninvasive measure, may be a risk marker for HF.