Abstract
To obtain reliable data on the epidemiology, co-morbidities and risk factor profile of peripheral arterial disease (PAD), we evaluated the clinical significance of the ankle brachial index (ABI) as an indicator of PAD in Chinese patients at high cardiovascular (CV) risk. ABI was measured in 5,646 Chinese patients at high CV risk, and PAD was defined as an ABI<0.9 in either leg. Multivariable logistic regression analyses were performed to identify factors associated with PAD. A total of 5,263 patients were analyzed, 52.9% male, mean age 67.3 years, mean body mass index (BMI) 24.2 kg/m2, mean systolic/diastolic blood pressure (SBP/DBP) 139/80.7 mmHg. The prevalence of PAD in the total group of patients was 25.4%, and the prevalence was higher in females than in males (27.1% vs. 23.9%; odds ratio [OR]: 1.64). Patients with PAD were older than those without PAD (72.3±9.9 years vs. 65.6±11.7 years; OR: 1.06), and more frequently had diabetes (43.3% vs. 31.3%; OR: 2.02), coronary heart disease (CHD) (27.0% vs. 18.8%; OR: 1.67), stroke (44.4% vs. 28.3%; OR: 1.78), lipid disorders (57.2% vs. 50.7%; OR: 1.3) and a smoking habit (42.7% vs. 38.6%; OR: 1.52). The ORs for the PAD group compared with the non-PAD group demonstrated that these conditions were inversely related to ABI. Statin, angiotensin-converting enzyme-inhibitors and antiplatelet agents were only used in 40.5%, 53.6% and 69.1% of PAD patients, respectively. The data demonstrated the high prevalence and low treatment of PAD in Chinese patients at high CV risk. A lower ABI was associated with generalized atherosclerosis. Based on these findings, ABI should be a routine measurement in high risk patients. Aggressive medication was required in these patients.
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Ouriel K : Peripheral arterial disease. Lancet 2001; 358: 1257–1264.
McDermott MM, Greenland P, Liu K, et al: The ankle brachial index is associated with leg function and physical activity: the Walking and Leg Circulation Study. Ann Intern Med 2002; 136: 873–883.
Criqui MH, Denenberg JO, Bird CE, et al: The correlation between symptoms and non-invasive test results in patients referred for peripheral arterial disease testing. Vasc Med 1996; 1: 65–71.
Diehm C, Schuster A, Allenberg JR, et al: High prevalence of PAD and co-morbidity in 6880 primary care patients: cross-sectional study. Atherosclerosis 2004; 172: 95–105.
Richey Sharrett A, Coady Sean A, Folsom Aaron R : Smoking and diabetes differ in their associations with subclinical atherosclerosis and coronary heart disease—the ARIC Study. Atherosclerosis 2004; 172: 143–149.
Ögren M, Hedblad B, Engström G, Janzon L : Prevalence and prognostic significance of asymptomatic peripheral arterial disease in 68-year-old men with diabetes. Results from the population study ‘Men Born in 1914’ from Malmö, Sweden. Eur J Vasc Endovasc Surg 2005; 29: 182–189.
Greenland P, Abrams I, Aurigemma GP, et al: Prevention Conference V: beyond secondary prevention: identifying the high-risk patient for primary prevention: non-invasive tests of atherosclerotic burden: Writing Group III. Circulation 2000; 101: E16–E22.
Brevetti G, Oliva G, Silvestro A, et al: Prevalence, risk factors and cardiovascular comorbidity of symptomatic peripheral arterial disease in Italy. Atherosclerosis 2004; 175: 131–138.
Otah KE, Madan A, Otah E, et al: Usefulness of an abnormal ankle-brachial index to predict presence of coronary artery disease in African-Americans. Am J Cardiol 2004; 93: 481–483.
Belch W, Topol ES, Agnelli GM : Critical issues in peripheral arterial disease detection and management: a call to action. Arch Intern Med 2003; 163: 884–892.
Yamashina A, Tomiyama H, Takeda K, et al: Validity, reproducibility, and clinical significance of noninvasive brachial-ankle pulse wave velocity measurement. Hypertens Res 2002; 25: 359–364.
Imanishi R, Seto S, Toda G, et al: High brachial-ankle pulse wave velocity is an independent predictor of the presence of coronary artery disease in men. Hypertens Res 2004; 27: 71–78.
Hiatt WR : Medical treatment of peripheral arterial disease and claudication. N Engl J Med 2001, 344: 1608–1621.
Dormandy JA, Rutherford RB, TASC Working Group: Management of peripheral arterial disease (PAD). J Vasc Surg 2000; 31: S1–S296.
Tsai AW, Folsom AR, Rosamond WD, Jones DW : Ankle-brachial index and 7-year ischemic stroke incidence: the ARIC study. Stroke 2001; 32: 1721–1724.
Meyer WT, Grobbee DE, Hunink MG, Hofman A, Hoes AW : Determinants of peripheral arterial disease in the elderly: the Rotterdam study. Arch Intern Med 2000; 160: 2934–2938.
Hooi JD, Stoffers HEJH, Kester ADM : Risk factors and cardiovascular diseases associated with asymptomatic peripheral arterial occlusive disease. The Limburg PAOD Study. Scand J Prim Health Care 1998; 16: 178–182.
Newman AB, Shemanski L, Manolio TA, et al, The Cardiovascular Health Study Group: Ankle-arm index as a predictor of cardiovascular disease and mortality in the Cardiovascular Health Study. Arterioscler Thromb Vasc Biol 1999; 19: 538–545.
Hirsch AT, Halverson SL, Treat-Jacobson D, et al: Peripheral arterial disease detection, awareness, and treatment in primary care. J Am Med Assoc 2001; 286: 1317–1324.
Barzilay JI, Spiekerman CF, Kuller LH, et al: Prevalence of clinical and isolated subclinical cardiovascular disease in older adults with glucose disorders: the Cardiovascular Health Study. Diab Care 2001; 24: 1233–1239.
Stavros A, Stelios K, Fotini S, et al: High prevalence of subclinical peripheral artery disease in Greek hospitalized patients. Eur J Intern Med 2005; 16: 187–191.
Hirsch AT, Halverson SL, Treat-Jacobson D, et al: The Minnesota Regional Peripheral Arterial Disease Screening Program: towards a definition of community standards of care. Vasc Med 2001; 6: 87–96.
Orchard TJ, Strandness DE : Assessment of peripheral vascular disease in diabetes: report and recommendations of an international workshop sponsored by the American Diabetes Association and the American Heart Association, 18–20 September, 1992 New Orleans, Louisiana. Circulation 1993; 88: 819–828.
Halperin JL, Fuster V : Meeting the challenge of peripheral arterial disease. Arch Intern Med 2003; 163: 877–878.
Shinozaki T, Hasegawa T, Yano E : Ankle-arm index as an indicator of atherosclerosis: its application as a screening method. J Clin Epidemiol 1998; 51: 1263–1269.
Resnick HE, Lindsay RS, McDermott MM : Relationship of high and low ankle brachial index to all-cause and cardiovascular disease mortality: the Strong Heart Study. Circulation 2004; 109: 733–739.
Nakanishi N, et al: Brachial-ankle pulse wave velocity and metabolic syndrome in a Japanese population. Hypertens Res 2005; 28: 125–131.
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Hasimu, B., Li, J., Nakayama, T. et al. Ankle Brachial Index as a Marker of Atherosclerosis in Chinese Patients with High Cardiovascular Risk. Hypertens Res 29, 23–28 (2006). https://doi.org/10.1291/hypres.29.23
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DOI: https://doi.org/10.1291/hypres.29.23
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