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Results From the Atherosclerosis Risk in Communities Study

Ann M. O’Hare, MA, MD; Rudolph A. Rodriguez, MD; Peter Bacchetti, PhD

Arch Intern Med. 2005;165:1481-1485.

Background  A low ankle-brachial index (ABI) predicts risk of cardiovascular death, myocardial infarction, peripheral arterial disease events, and stroke. However, it is unknown whether a low ABI also predicts a decline in renal function.

Methods  We examined the association between ABI and change in serum creatinine level over time among 13 655 participants in the Atherosclerosis Risk in Communities (ARIC) study who underwent serum creatinine and ABI measurement at baseline and also underwent serum creatinine measurement 3 years later at the second study visit. The study outcome was a 50% rise in serum creatinine level from baseline to the second study visit.

Results  Overall, 0.48% of participants with an ABI of 1 or higher, 0.9% of participants with an ABI between 0.9 and 0.99, and 2.16% of participants with an ABI lower than 0.9 experienced a 50% or greater increase in serum creatinine level. In multivariate analysis, participants with an ABI lower than 0.9 were still more than twice as likely as those in the referent category (ABI 1) to experience an increase in serum creatinine level (odds ratio 2.5; 95% confidence interval, 1.1-5.7) (P = .04), and a linear trend in the incidence of worsening renal function was noted across ABI categories (P = .02). Analyses excluding participants with renal insufficiency, diabetes, and hypertension at baseline all produced similar results.

Conclusion  In addition to known associations of the ABI with stroke, myocardial infarction, peripheral arterial disease events, and cardiovascular death, a low ABI also predicts an increase in serum creatinine level over time.

Author Affiliations: Departments of Medicine (Drs O’Hare and Rodriguez) and Epidemiology and Biostatistics (Dr Bacchetti), University of California, and Departments of Medicine, Veterans Affairs Medical Center (Dr O’Hare) and San Francisco General Hospital (Dr Rodriguez), San Francisco, Calif.

RELATED LETTERS

Systemic Atherosclerosis and Kidney Disease
Abhijit V. Kshirsagar and Romulo E. Colindres
Arch Intern Med. 2006;166(2):250.
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Systemic Atherosclerosis and Kidney Disease—Reply
Ann M. O’Hare, Rudolph A. Rodriguez, and Peter Bacchetti
Arch Intern Med. 2006;166(2):250.
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