Associations of Borderline and Low Normal Ankle-brachial Index Values with Functional Decline at 5-year Follow-up: the WALCS (Walking and Leg Circulation Study)

Overview

Journal J Am Coll Cardiol

Specialty Cardiology & Vascular Diseases

Date 2009 Mar 21

PMID 19298919

Citations 94

Authors

Mary M McDermott

Jack M Guralnik

Lu Tian

Kiang Liu

Luigi Ferrucci

Yihua Liao

Leena Sharma

Michael H Criqui

Affiliations

Soon will be listed here.

Abstract

Objectives: We studied associations of borderline and low normal ankle-brachial index (ABI) values with functional decline over a 5-year follow-up.

Background: The associations of borderline and low normal ABI with functional decline are unknown.

Methods: The 666 participants included 412 with peripheral arterial disease (PAD). Participants were categorized as follows: severe PAD (ABI <0.50), moderate PAD (ABI 0.50 to 0.69), mild PAD (ABI 0.70 to 0.89), borderline ABI (0.90 to 0.99), low normal ABI (1.00 to 1.09), and normal ABI (ABI 1.10 to 1.30). Outcomes were assessed annually for 5 years. Mobility loss was defined as loss of the ability to walk one-quarter mile or walk up and down 1 flight of stairs without assistance among participants without baseline mobility impairment. Becoming unable to walk for 6 min continuously was defined as stopping during the 6-min walk at follow-up among those who walked for 6 min continuously at baseline. Results were adjusted for age, sex, race, comorbidities, and other confounders.

Results: Hazard ratios (HRs) for mobility loss according to ABI category were as follows: severe PAD, HR: 4.16 (95% confidence interval [CI]: 1.58 to 10.92); moderate PAD, HR: 3.82 (95% CI: 1.66 to 8.81); mild PAD, HR: 3.22 (95% CI: 1.43 to 7.21); borderline ABI, HR: 3.07 (95% CI: 1.21 to 7.84); and low normal ABI, HR: 2.61 (95% CI: 1.08 to 6.32; p trend = 0.0018). Similar associations were observed for becoming unable to walk for 6 min continuously (p trend < 0.0001).

Conclusions: At 5-year follow-up, persons with borderline ABI values have a higher incidence of mobility loss and becoming unable to walk for 6 min continuously compared with persons who have a normal baseline ABI. A low normal ABI is associated with an increased incidence of mobility loss compared with persons who have a normal ABI.

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References

McDermott M, Kerwin D, Liu K, Martin G, OBrien E, Kaplan H . Prevalence and significance of unrecognized lower extremity peripheral arterial disease in general medicine practice*. J Gen Intern Med. 2001; 16(6):384-90. PMC: 1495229. DOI: 10.1046/j.1525-1497.2001.016006384.x. View

Guyatt G, Sullivan M, Thompson P, Fallen E, Pugsley S, Taylor D . The 6-minute walk: a new measure of exercise capacity in patients with chronic heart failure. Can Med Assoc J. 1985; 132(8):919-23. PMC: 1345899. View

Shadman R, Criqui M, Bundens W, Fronek A, Denenberg J, Gamst A . Subclavian artery stenosis: prevalence, risk factors, and association with cardiovascular diseases. J Am Coll Cardiol. 2004; 44(3):618-23. DOI: 10.1016/j.jacc.2004.04.044. View

McDermott M, Criqui M, Liu K, Guralnik J, Greenland P, Martin G . Lower ankle/brachial index, as calculated by averaging the dorsalis pedis and posterior tibial arterial pressures, and association with leg functioning in peripheral arterial disease. J Vasc Surg. 2000; 32(6):1164-71. DOI: 10.1067/mva.2000.108640. View

McDermott M, Liu K, Greenland P, Guralnik J, Criqui M, Chan C . Functional decline in peripheral arterial disease: associations with the ankle brachial index and leg symptoms. JAMA. 2004; 292(4):453-61. DOI: 10.1001/jama.292.4.453. View

Resnick H, Lindsay R, McDermott M, Devereux R, Jones K, Fabsitz R . Relationship of high and low ankle brachial index to all-cause and cardiovascular disease mortality: the Strong Heart Study. Circulation. 2004; 109(6):733-9. DOI: 10.1161/01.CIR.0000112642.63927.54. View

McDermott M, Criqui M, Ferrucci L, Guralnik J, Tian L, Liu K . Obesity, weight change, and functional decline in peripheral arterial disease. J Vasc Surg. 2006; 43(6):1198-204. PMC: 2645620. DOI: 10.1016/j.jvs.2006.02.036. View

Rosamond W, Flegal K, Friday G, Furie K, Go A, Greenlund K . Heart disease and stroke statistics--2007 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2006; 115(5):e69-171. DOI: 10.1161/CIRCULATIONAHA.106.179918. View

Hirsch A, Criqui M, Regensteiner J, Creager M, Olin J, Krook S . Peripheral arterial disease detection, awareness, and treatment in primary care. JAMA. 2001; 286(11):1317-24. DOI: 10.1001/jama.286.11.1317. View

10.

Patel K, Coppin A, Manini T, Lauretani F, Bandinelli S, Ferrucci L . Midlife physical activity and mobility in older age: The InCHIANTI study. Am J Prev Med. 2006; 31(3):217-24. PMC: 2646092. DOI: 10.1016/j.amepre.2006.05.005. View

11.

Allison M, Ho E, Denenberg J, Langer R, Newman A, Fabsitz R . Ethnic-specific prevalence of peripheral arterial disease in the United States. Am J Prev Med. 2007; 32(4):328-33. DOI: 10.1016/j.amepre.2006.12.010. View

12.

Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K . Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Arthritis Rheum. 1986; 29(8):1039-49. DOI: 10.1002/art.1780290816. View

13.

McDermott M, Greenland P, Liu K, Guralnik J, Criqui M, Dolan N . Leg symptoms in peripheral arterial disease: associated clinical characteristics and functional impairment. JAMA. 2001; 286(13):1599-606. DOI: 10.1001/jama.286.13.1599. View

14.

Guralnik J, Simonsick E, Ferrucci L, Glynn R, Berkman L, Blazer D . A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol. 1994; 49(2):M85-94. DOI: 10.1093/geronj/49.2.m85. View

15.

Newman A, Siscovick D, Manolio T, Polak J, Fried L, Borhani N . Ankle-arm index as a marker of atherosclerosis in the Cardiovascular Health Study. Cardiovascular Heart Study (CHS) Collaborative Research Group. Circulation. 1993; 88(3):837-45. DOI: 10.1161/01.cir.88.3.837. View

16.

Altman R, Alarcon G, Appelrouth D, Bloch D, Borenstein D, Brandt K . The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hip. Arthritis Rheum. 1991; 34(5):505-14. DOI: 10.1002/art.1780340502. View

17.

McDermott M, Greenland P, Liu K, Guralnik J, Celic L, Criqui M . The ankle brachial index is associated with leg function and physical activity: the Walking and Leg Circulation Study. Ann Intern Med. 2002; 136(12):873-83. DOI: 10.7326/0003-4819-136-12-200206180-00008. View

18.

Montgomery P, Gardner A . The clinical utility of a six-minute walk test in peripheral arterial occlusive disease patients. J Am Geriatr Soc. 1998; 46(6):706-11. DOI: 10.1111/j.1532-5415.1998.tb03804.x. View

19.

Lijmer J, Hunink M, van den Dungen J, Loonstra J, Smit A . ROC analysis of noninvasive tests for peripheral arterial disease. Ultrasound Med Biol. 1996; 22(4):391-8. DOI: 10.1016/0301-5629(96)00036-1. View

20.

Wang J, Criqui M, Denenberg J, McDermott M, Golomb B, Fronek A . Exertional leg pain in patients with and without peripheral arterial disease. Circulation. 2005; 112(22):3501-8. PMC: 4285459. DOI: 10.1161/CIRCULATIONAHA.105.548099. View