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The Framingham Study

Joanne M. Murabito, MD, ScM; Jane C. Evans, DSc; Martin G. Larson, ScD; Kenneth Nieto, MA; Daniel Levy, MD; Peter W. F. Wilson, MD

Arch Intern Med. 2003;163:1939-1942.

Background  A low ankle-brachial index (ABI) is associated with an increased risk of death and cardiovascular disease. Limited data exist regarding the relation between a low ABI and stroke. We sought to examine the relation between a low ABI and stroke, coronary heart disease, and death in the elderly.

Methods  We examined 251 men and 423 women with a mean age of 80 years who had a Framingham Study examination from 1994 to 1995. A low ABI was defined as less than 0.9. Persons were followed up for 4 years for occurrence of stroke or transient ischemic attack, coronary disease, and death. Cox proportional hazards models were used to assess the relation between a low ABI and each outcome after adjusting for age, sex, and prevalent cardiovascular disease.

Results  A low ABI was detected in 20% of our sample. Only 18% of the participants with a low ABI reported claudication symptoms. One third of those with a normal ABI and 55% of those with a low ABI had cardiovascular disease at baseline. Results of multivariable Cox proportional hazards analysis demonstrated a statistically significant increase in the risk of stroke or transient ischemic attack in persons with a low ABI (hazards ratio, 2.0; 95% confidence interval, 1.1-3.7). No significant relation between a low ABI and coronary heart disease (hazards ratio, 1.2; 95% confidence interval, 0.7-2.1) or death (hazards ratio, 1.4; 95% confidence interval, 0.9-2.1) was observed.

Conclusions  A low ABI is associated with risk of stroke or transient ischemic attack in the elderly. These results need to be confirmed in larger studies.

From the National Heart, Lung, and Blood Institute's Framingham Heart Study, National Institutes of Health, Framingham, Mass (Drs Murabito, Evans, Larson, Levy, and Wilson, and Mr Nieto); the Sections of General Internal Medicine (Dr Murabito), Preventive Medicine (Drs Evans, Levy, and Wilson), and Endocrinology (Dr Wilson), Boston University School of Medicine, Boston, Mass; and the National Heart, Lung, and Blood Institute, Bethseda, Md (Dr Levy). The authors have no relevant financial interest in this article.

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