The Ankle-Brachial Index in the Elderly and Risk of Stroke, Coronary Disease, and Death

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Abstract
A LOW ankle-brachial index (ABI) is common in the elderly and the prevalence exceeds 25% in persons older than 85 years.1-4 In middle-aged and older adults a low ABI has been reported to be associated with an increased risk of death, total cardiovascular disease (CVD), coronary heart disease (CHD), congestive heart failure, and symptomatic peripheral arterial disease.5-12 Risk for all-cause mortality is increased 2- to 4-fold in persons with a low ABI6-9 while risk of death from coronary disease is increased more than 6-fold in middle-aged adults6 and more than 3-fold in older adults.7,8 Peripheral arterial disease that is symptomatic and severe increased cardiovascular and CHD mortality 15-fold.6 Limited data are available on the relation between ABI and risk of stroke. Studies of men with symptoms of lower extremity arterial disease have reported an increased risk of stroke death.13-15 Decreasing ABI levels have been associated with a higher prevalence of self-reported stroke or transient ischemic attack (TIA) in middle-aged adults.16 The Honolulu Heart Program recently reported an increased risk of stroke with declining ABI levels in elderly men.17 We had the opportunity to examine the relation between low ABI and risk of stroke, CHD, and death in elderly adults participating in the Framingham Heart Study.