Coronary heart disease (CHD), stroke, and heart failure (HF) are associated with low ankle-brachial index (ABI), according to study findings published in Atherosclerosis.

The Atherosclerosis Risk in Communities (ARIC) study was a community-based cohort that included patients aged 45-64 years, who enrolled during 1987-1989. Researchers enrolled participants from 4 locations in the United States. The 5003 participants who attended the fifth follow-up during 2011-2013 were included in the study and assessed for ABI and cardiovascular events.

There were 4160 without and 843 with atherosclerotic cardiovascular disease (ASCVD). These populations had a median age of 74 and 76 years, and 38% and 65% were men, respectively. Individuals who had lower ABI and no ASCVD tended to be Black, current smokers, on cholesterol medication, have less education, and less income. Individuals with the highest ABI (>1.30) were more likely to be White men.

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There were 400 CHD or stroke and 338 HF events over a follow-up of 5.5 years.

Among the no-ASCVD cohort, compared with an ABI of 1.11-1.20, CHD and stroke risk was increased among individuals with ABI less than or equal to 0.90 (adjusted hazard ratio [aHR], 2.40; 95% CI, 1.55-3.71) and ABI 1.01-1.10 (aHR, 1.45; 95% CI, 1.04-2.02) and HF with ABI less than or equal to 0.90 (aHR, 2.23; 95% CI, 1.40-3.56).

In a subgroup analysis, risk for CHD and stroke per 0.1 increase in ABI among individuals with ABI less than or equal to 1.3 were consistent across most groups except ethnicity (P =.010), diabetes (P =.028), and hypertension (P =.019), in which risk was ameliorated among White individuals and those without diabetes or hypertension.

For the ASCVD cohort, compared with ABI greater than 1.30, no ABI groups were associated with increased risk for CHD or stroke, but all other ABI groups were associated with increased HF risk. The highest risk associated with ABI less than or equal to 0.90 (aHR, 7.12; 95% CI, 2.47-20.50), followed by 0.91-1.00 (aHR, 6.55; 95% CI, 2.24-19.17), 1.01-1.10 (aHR, 4.81; 95% CI, 1.68-13.75), greater than 1.30 (aHR, 3.12; 95% CI, 1.00-9.73), and 1.11-1.20 (aHR, 3.01; 95% CI, 1.06-8.58).

Incorporating ABI to ASCVD risk scores improved the predictive ability for CHD and stroke (DC, 0.012; 95% CI, 0.000-0.024), HF (DC, 0.014; 95% CI, 0.000-0.029), and CHD (DC, 0.029; 95% CI, 0.004-0.054) among the no-ASCVD cohort and for HF (DC, 0.066; 95% CI, 0.017-0.114) among the ASCVD group.

This study was limited, as ABI was assessed using an oscillometric device, which has been shown to be prone to misclassification. Current guidelines are to use a Doppler probe approach.

The data indicated that low ABI among older adults was robustly associated with HF among all individuals and CHD and stroke risk among those without ASCVD.

“These findings support the use of low ABI as a risk enhancer in helping guide primary prevention for CHD/stroke and suggest that ABI may be a strong, non-invasive predictor for assessing HF risk in older adults,” the study authors said.

Disclosure: An author declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Wang FM, Yang C, Ballew SH, et al. Ankle-brachial index and subsequent risk of incident and recurrent cardiovascular events in older adults: The Atherosclerosis Risk in Communities (ARIC) study. Atherosclerosis. Published online October 6, 2021. doi:10.1016/j.atherosclerosis.2021.09.028

This article originally appeared on The Cardiology Advisor