Ankle brachial index screening in asymptomatic older adults

Ruth E Taylor-Piliae, Joan M. Fair, Ann N. Varady, Mark A. Hlatky, Linda C. Norton, Carlos Iribarren, Alan S. Go, Stephen P. Fortmann

Research output: Contribution to journalArticle

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Abstract

Background: Screening for peripheral arterial disease (PAD) by measuring ankle brachial index (ABI) in asymptomatic older adults is currently recommended to improve cardiovascular disease risk assessment and establish early treatment, but it is not clear if the strategy is useful in all populations. We examined the prevalence and independent predictors of an abnormal ABI (<0.90), in an asymptomatic sample of 1,017 adults, 60 to 69 years old, enrolled in the ADVANCE study. Methods: Baseline data collected between December 2001 and January 2004 among the healthy older controls enrolled in ADVANCE was examined. Frequency distributions and prevalence estimates of an abnormal ABI were calculated, using both standard and modified definitions of ABI. Stepwise logistic regression was used to examine independent predictors of ABI <0.90. Signal detection analysis using recursive partitioning was employed to explore potential demographic and clinical variables related to ABI <0.90. Results: The prevalence of ABI <0.90 was 2% when using the standard definition and 5% when using a modified definition. ABI prevalence did not differ by gender (P > .05). Compared with subjects who had a normal ABI (0.90-1.39), subjects with an ABI <0.90 were more likely to currently smoke, be physically inactive, have a coronary artery calcium score >10, and an FRS >20% (P ≤ .02). Independent predictors of ABI <0.90 when using the standard definition included currently smoking, physical inactivity, and body mass index >30 (all P values ≤.03), and when using the modified definition included currently smoking, physical inactivity, and hypertension (all P values ≤.04). Currently, smoking was the only significant variable for ABI <0.90 derived through recursive partitioning (P = .02), and indicated that prevalence of ABI <0.90 was 1.5% for nonsmokers, while it was 6.6% for current smokers. Conclusions: ABI screening in generally healthy individuals 60 to 69 years old may result in lower prevalence rates of a positive result than estimates based on studies in clinical populations. The modified definition for calculating ABI captured more asymptomatic adults with suspected peripheral arterial disease. More evaluation of the appropriate role of ABI screening in unselected populations is needed before routine screening is implemented.

Original languageEnglish (US)
Pages (from-to)979-985
Number of pages7
JournalAmerican Heart Journal
Volume161
Issue number5
DOIs
StatePublished - May 2011

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Ankle Brachial Index
Peripheral Arterial Disease
Smoking
Population
Cardiovascular Diseases
Hypertension

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Taylor-Piliae, R. E., Fair, J. M., Varady, A. N., Hlatky, M. A., Norton, L. C., Iribarren, C., ... Fortmann, S. P. (2011). Ankle brachial index screening in asymptomatic older adults. American Heart Journal, 161(5), 979-985. https://doi.org/10.1016/j.ahj.2011.02.003

Ankle brachial index screening in asymptomatic older adults. / Taylor-Piliae, Ruth E; Fair, Joan M.; Varady, Ann N.; Hlatky, Mark A.; Norton, Linda C.; Iribarren, Carlos; Go, Alan S.; Fortmann, Stephen P.

In: American Heart Journal, Vol. 161, No. 5, 05.2011, p. 979-985.

Research output: Contribution to journalArticle

Taylor-Piliae, RE, Fair, JM, Varady, AN, Hlatky, MA, Norton, LC, Iribarren, C, Go, AS & Fortmann, SP 2011, 'Ankle brachial index screening in asymptomatic older adults', American Heart Journal, vol. 161, no. 5, pp. 979-985. https://doi.org/10.1016/j.ahj.2011.02.003
Taylor-Piliae RE, Fair JM, Varady AN, Hlatky MA, Norton LC, Iribarren C et al. Ankle brachial index screening in asymptomatic older adults. American Heart Journal. 2011 May;161(5):979-985. https://doi.org/10.1016/j.ahj.2011.02.003
Taylor-Piliae, Ruth E ; Fair, Joan M. ; Varady, Ann N. ; Hlatky, Mark A. ; Norton, Linda C. ; Iribarren, Carlos ; Go, Alan S. ; Fortmann, Stephen P. / Ankle brachial index screening in asymptomatic older adults. In: American Heart Journal. 2011 ; Vol. 161, No. 5. pp. 979-985.
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abstract = "Background: Screening for peripheral arterial disease (PAD) by measuring ankle brachial index (ABI) in asymptomatic older adults is currently recommended to improve cardiovascular disease risk assessment and establish early treatment, but it is not clear if the strategy is useful in all populations. We examined the prevalence and independent predictors of an abnormal ABI (<0.90), in an asymptomatic sample of 1,017 adults, 60 to 69 years old, enrolled in the ADVANCE study. Methods: Baseline data collected between December 2001 and January 2004 among the healthy older controls enrolled in ADVANCE was examined. Frequency distributions and prevalence estimates of an abnormal ABI were calculated, using both standard and modified definitions of ABI. Stepwise logistic regression was used to examine independent predictors of ABI <0.90. Signal detection analysis using recursive partitioning was employed to explore potential demographic and clinical variables related to ABI <0.90. Results: The prevalence of ABI <0.90 was 2{\%} when using the standard definition and 5{\%} when using a modified definition. ABI prevalence did not differ by gender (P > .05). Compared with subjects who had a normal ABI (0.90-1.39), subjects with an ABI <0.90 were more likely to currently smoke, be physically inactive, have a coronary artery calcium score >10, and an FRS >20{\%} (P ≤ .02). Independent predictors of ABI <0.90 when using the standard definition included currently smoking, physical inactivity, and body mass index >30 (all P values ≤.03), and when using the modified definition included currently smoking, physical inactivity, and hypertension (all P values ≤.04). Currently, smoking was the only significant variable for ABI <0.90 derived through recursive partitioning (P = .02), and indicated that prevalence of ABI <0.90 was 1.5{\%} for nonsmokers, while it was 6.6{\%} for current smokers. Conclusions: ABI screening in generally healthy individuals 60 to 69 years old may result in lower prevalence rates of a positive result than estimates based on studies in clinical populations. The modified definition for calculating ABI captured more asymptomatic adults with suspected peripheral arterial disease. More evaluation of the appropriate role of ABI screening in unselected populations is needed before routine screening is implemented.",
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AU - Fair, Joan M.

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AU - Norton, Linda C.

AU - Iribarren, Carlos

AU - Go, Alan S.

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N2 - Background: Screening for peripheral arterial disease (PAD) by measuring ankle brachial index (ABI) in asymptomatic older adults is currently recommended to improve cardiovascular disease risk assessment and establish early treatment, but it is not clear if the strategy is useful in all populations. We examined the prevalence and independent predictors of an abnormal ABI (<0.90), in an asymptomatic sample of 1,017 adults, 60 to 69 years old, enrolled in the ADVANCE study. Methods: Baseline data collected between December 2001 and January 2004 among the healthy older controls enrolled in ADVANCE was examined. Frequency distributions and prevalence estimates of an abnormal ABI were calculated, using both standard and modified definitions of ABI. Stepwise logistic regression was used to examine independent predictors of ABI <0.90. Signal detection analysis using recursive partitioning was employed to explore potential demographic and clinical variables related to ABI <0.90. Results: The prevalence of ABI <0.90 was 2% when using the standard definition and 5% when using a modified definition. ABI prevalence did not differ by gender (P > .05). Compared with subjects who had a normal ABI (0.90-1.39), subjects with an ABI <0.90 were more likely to currently smoke, be physically inactive, have a coronary artery calcium score >10, and an FRS >20% (P ≤ .02). Independent predictors of ABI <0.90 when using the standard definition included currently smoking, physical inactivity, and body mass index >30 (all P values ≤.03), and when using the modified definition included currently smoking, physical inactivity, and hypertension (all P values ≤.04). Currently, smoking was the only significant variable for ABI <0.90 derived through recursive partitioning (P = .02), and indicated that prevalence of ABI <0.90 was 1.5% for nonsmokers, while it was 6.6% for current smokers. Conclusions: ABI screening in generally healthy individuals 60 to 69 years old may result in lower prevalence rates of a positive result than estimates based on studies in clinical populations. The modified definition for calculating ABI captured more asymptomatic adults with suspected peripheral arterial disease. More evaluation of the appropriate role of ABI screening in unselected populations is needed before routine screening is implemented.

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