This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Tsai, A. W. Articles by Jones, D. W. Search for Related Content PubMed PubMed Citation Articles by Tsai, A. W. Articles by Jones, D. W. Pubmed/NCBI databases Medline Plus Health Information Stroke Related Collections Risk Factors Other diagnostic testing Acute Cerebral Infarction Epidemiology

(Stroke. 2001;32:1721.)
© 2001 American Heart Association, Inc.

Original Contributions

Ankle-Brachial Index and 7-Year Ischemic Stroke Incidence

The ARIC Study

Albert W. Tsai, MPH; Aaron R. Folsom, MD; Wayne D. Rosamond, PhD Daniel W. Jones, MD

From the Division of Epidemiology (A.W.T., A.R.F.), School of Public Health, University of Minnesota (Minneapolis); Collaborative Studies Coordinating Center (W.D.R.), Department of Epidemiology, School of Public Health, University of North Carolina–Chapel Hill; and Division of Hypertension (D.W.J.), University of Mississippi Medical Center (Jackson).

Correspondence to Dr Aaron Folsom, Division of Epidemiology, School of Public Health, University of Minnesota, 1300 South 2nd St, Suite 300, Minneapolis, MN 55454. E-mail folsom{at}epi.umn.edu

Background and Purpose—— Low ankle-brachial index (ABI), which is the ratio of tibial artery systolic blood pressure to brachial systolic artery pressure, is known to be a measure of lower limb peripheral artery disease as well as a marker for other cardiovascular disease events. The ability of ABI to predict incident ischemic stroke, however, is not established in population-based studies.

Methods—— ABI was measured in a cohort of 14 839 black and white men and women aged 45 to 64 years. Stroke incidence was calculated during approximately 7 years of follow-up.

Results—— A total of 206 incident strokes occurred. Adjusted stroke incidence rates were markedly higher for those in the lowest versus the highest categories of ABI for men, women, blacks, and whites. The proportional hazards regression model, adjusted for age, race, gender, and field center, showed an inverse linear trend between ABI and ischemic stroke incidence (P<0.0001). The lowest group (ABI <0.80) had a hazard ratio of 5.68 (95% CI 2.77 to 11.66). After adjustment for major risk factors in a multivariate model, the hazard ratio in the lowest group was elevated (1.93) but no longer statistically significant (95% CI 0.78 to 4.78). There was, however, still an indication of an overall inverse linear trend between ABI and incident stroke (P=0.03).

Conclusions—— Low ABI was strongly associated with increased incidence of ischemic stroke, but the relationship was substantially reduced after adjustment for major cardiovascular risk factors.

Key Words: brachial artery • cerebral infarction • epidemiology • tibial artery

This article has been cited by other articles:

				C. Diehm, J. R. Allenberg, D. Pittrow, M. Mahn, G. Tepohl, R. L. Haberl, H. Darius, I. Burghaus, H. J. Trampisch, and for the German Epidemiological Trial on Ankle Brac Mortality and Vascular Morbidity in Older Adults With Asymptomatic Versus Symptomatic Peripheral Artery Disease Circulation, November 24, 2009; 120(21): 2053 - 2061. [Abstract] [Full Text] [PDF]

				S. Tavintharan, Ning Cheung, Su Chi Lim, W. Tay, A. Shankar, E. Shyong Tai, and T. Y. Wong Prevalence and risk factors for peripheral artery disease in an Asian population with diabetes mellitus Diabetes and Vascular Disease Research, April 1, 2009; 6(2): 80 - 86. [Abstract] [PDF]

				C Weimar, M Goertler, J Rother, E B Ringelstein, H Darius, D G Nabavi, I.-H. Kim, J. Benemann, H.-C. Diener, and on behalf of the SCALA Study Group Predictive value of the Essen Stroke Risk Score and Ankle Brachial Index in acute ischaemic stroke patients from 85 German stroke units J. Neurol. Neurosurg. Psychiatry, December 1, 2008; 79(12): 1339 - 1343. [Abstract] [Full Text] [PDF]

				M. H. Criqui, J. K. Ninomiya, D. L. Wingard, M. Ji, and A. Fronek Progression of Peripheral Arterial Disease Predicts Cardiovascular Disease Morbidity and Mortality J. Am. Coll. Cardiol., November 18, 2008; 52(21): 1736 - 1742. [Abstract] [Full Text] [PDF]

				I. Kardys, R. Vliegenthart, M. Oudkerk, A. Hofman, and J. C. M. Witteman The Female Advantage in Cardiovascular Disease: Do Vascular Beds Contribute Equally? Am. J. Epidemiol., August 15, 2007; 166(4): 403 - 412. [Abstract] [Full Text] [PDF]

				C. Christodoulou, S. Sangle, and D. P. D'Cruz Vasculopathy and arterial stenotic lesions in the antiphospholipid syndrome Rheumatology, June 1, 2007; 46(6): 907 - 910. [Abstract] [Full Text] [PDF]

				C. Lamina, C. Meisinger, I. M. Heid, H. Lowel, B. Rantner, W. Koenig, F. Kronenberg, and for the KORA Study Group Association of ankle-brachial index and plaques in the carotid and femoral arteries with cardiovascular events and total mortality in a population-based study with 13 years of follow-up Eur. Heart J., November 1, 2006; 27(21): 2580 - 2587. [Abstract] [Full Text] [PDF]

				A. M. O'Hare, R. Katz, M. G. Shlipak, M. Cushman, and A. B. Newman Mortality and Cardiovascular Risk Across the Ankle-Arm Index Spectrum: Results From the Cardiovascular Health Study Circulation, January 24, 2006; 113(3): 388 - 393. [Abstract] [Full Text] [PDF]

				P. Muntner, R. P. Wildman, K. Reynolds, K. B. DeSalvo, J. Chen, and V. Fonseca Relationship Between HbA1c Level and Peripheral Arterial Disease Diabetes Care, August 1, 2005; 28(8): 1981 - 1987. [Abstract] [Full Text] [PDF]

				A. M. O'Hare, R. A. Rodriguez, and P. Bacchetti Low Ankle-Brachial Index Associated With Rise in Creatinine Level Over Time: Results From the Atherosclerosis Risk in Communities Study Arch Intern Med, July 11, 2005; 165(13): 1481 - 1485. [Abstract] [Full Text] [PDF]

				A. V. Doobay and S. S. Anand Sensitivity and Specificity of the Ankle-Brachial Index to Predict Future Cardiovascular Outcomes: A Systematic Review Arterioscler Thromb Vasc Biol, July 1, 2005; 25(7): 1463 - 1469. [Abstract] [Full Text] [PDF]

				L. E. Chambless, G. Heiss, E. Shahar, M. J. Earp, and J. Toole Prediction of Ischemic Stroke Risk in the Atherosclerosis Risk in Communities Study Am. J. Epidemiol., August 1, 2004; 160(3): 259 - 269. [Abstract] [Full Text] [PDF]

				A Theodoridou, L Bento, D P D'Cruz, M A Khamashta, and G R V Hughes Prevalence and associations of an abnormal ankle-brachial index in systemic lupus erythematosus: a pilot study Ann Rheum Dis, December 1, 2003; 62(12): 1199 - 1203. [Abstract] [Full Text] [PDF]

				E. R. Mohler III Peripheral Arterial Disease: Identification and Implications Arch Intern Med, October 27, 2003; 163(19): 2306 - 2314. [Abstract] [Full Text] [PDF]

				M. Hollander, A.E. Hak, P.J. Koudstaal, M.L. Bots, D.E. Grobbee, A. Hofman, J.C.M. Witteman, and M.M.B. Breteler Comparison Between Measures of Atherosclerosis and Risk of Stroke: The Rotterdam Study Stroke, October 1, 2003; 34(10): 2367 - 2372. [Abstract] [Full Text] [PDF]

				J. M. Murabito, J. C. Evans, M. G. Larson, K. Nieto, D. Levy, and P. W. F. Wilson The Ankle-Brachial Index in the Elderly and Risk of Stroke, Coronary Disease, and Death: The Framingham Study Arch Intern Med, September 8, 2003; 163(16): 1939 - 1942. [Abstract] [Full Text] [PDF]

				W.T. Longstreth Jr, C. Dulberg, T. A. Manolio, M. R. Lewis, N. J. Beauchamp Jr, D. O'Leary, J. Carr, and C. D. Furberg Incidence, Manifestations, and Predictors of Brain Infarcts Defined by Serial Cranial Magnetic Resonance Imaging in the Elderly: The Cardiovascular Health Study Stroke, October 1, 2002; 33(10): 2376 - 2382. [Abstract] [Full Text] [PDF]