on February 7, 2008
Published online before print February 7, 2008, doi: 10.1161/STROKEAHA.107.487439
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Submitted on April 24, 2007
Department of Epidemiology (K.S.-T., L.V., R.B., T.T., R.H.M., A.B.N.), Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pa; Division of General Internal Medicine (A.M.K.), University of California, San Francisco, Ca and the UCSF Women's Health Clinical Research Center, San Francisco, Calif; Laboratory of Epidemiology, Demography, and Biometry (T.H.), Intramural Research Program, National Institute on Aging, Bethesda, Md; Institute of Health Sciences (M.V.), Faculty of Earth and Life Sciences, VU University and EMGO Institute, VU Medical Center, Amsterdam, The Netherlands; Department of Preventive Medicine, University of Tennessee (G.D.V.), Memphis, Tn. * To whom correspondence should be addressed. E-mail: Tyrrell{at}edc.pitt.edu.
Background and Purpose—Low values of ankle–arm systolic blood pressure ratio predict mortality and cardiovascular events. High values, associated with arterial calcification, also carry risk for mortality. We focus on the extent to which low and high ankle–arm index values as well as noncompressible arteries are associated with mortality and cardiovascular events, including stroke in older adults. Methods—We followed 2886 adults aged 70 to 79 for a mean of 6.7 years for vital status and cardiovascular events (coronary heart disease, stroke, and congestive heart failure). Results—Normal ankle–arm index values of 0.91 to 1.3 were found in 80%, low values of Conclusions—Among older adults, low and high ankle–arm index values carry elevated risk for cardiovascular events. Noncompressible leg arteries carry elevated risk for stroke and congestive heart failure specifically.
Revised on July 26, 2007
Accepted on August 15, 2007
Relationship of Ankle Blood Pressures to Cardiovascular Events in Older Adults
Kim Sutton-Tyrrell DrPH*;
0.9 were found in 13%, high values of >1.3 were obtained in 5%, and noncompressible arteries were found in 2% of the group. Increased mortality was associated with both low and high ankle–arm index values beginning at levels of <1.0 or 
1.4. Subjects with low ankle–arm index values or noncompressible arteries had significantly higher event rates than those with normal ankle blood pressures for all end points. For coronary heart disease, hazard ratios associated with a low ankle–arm index, high ankle–arm index, and noncompressible arteries were 1.4, 1.5, and 1.7 (P<0.05 for all) after controlling for age, gender, race, prevalent cardiovascular disease, diabetes, and major cardiovascular risk factors. Noncompressible arteries carried a particularly high risk of stroke and congestive heart failure (hazard ratio=2.1 and 2.4, respectively).
Key words: age • mortality • peripheral artery disease • stroke
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