Criqui MH et al. (2008) Progression of peripheral arterial disease predicts cardiovascular disease morbidity and mortality. J Am Coll Cardiol 52: 1736–1742

Researchers in California, USA have demonstrated that a decrease in ankle–brachial index (ABI) over time, an indicator of peripheral arterial disease progression, is predictive of cardiovascular risk.

In this study, 508 asymptomatic individuals who had undergone initial lower extremity arterial testing between 1980 and 1989 at two medical centers in San Diego, CA, were retested during 1990–1994. Overall, 16.7% of patients had a decrease in ABI of more than 0.15 between the two visits, which—when compared with a decrease of <0.15—was significantly and independently associated with all-cause mortality (risk ratio [RR] 2.4; P = 0.01) and with cardiovascular disease mortality (RR 2.8; P <0.01) at 3 years after the second visit. Very low (<0.7) and low (0.7–0.9) ABIs at the second visit were also significantly associated with increased risk of death, and cardiovascular disease morbidity and mortality at 3 and 6 years after enrollment. Eight individuals who had a high ABI (≥1.4) at the second visit were also identified as being at increased risk for 3-year cardiovascular disease mortality (RR 8.6; P = 0.03) and for combined CVD morbidity and mortality at 6 years (RR 2.5; P <0.05). The authors suggest that close monitoring of ABI in patients with suspected peripheral arterial disease could identify individuals who would benefit from intervention to prevent adverse cardiovascular events.