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The Cardiovascular Health Study

Margaret Kennedy, MD, MSc; Cam Solomon, PhD; Teri A. Manolio, MD, PhD; Michael H. Criqui, MD, MPH; Anne B. Newman, MD, MPH; Joseph F. Polak, MD, MPH; Gregory L. Burke, MD, MS; Paul Enright, MD; Mary Cushman, MD, MSc

Arch Intern Med. 2005;165:1896-1902.

Background  An ankle-brachial index (ABI) of less than 0.9 is a noninvasive measure of lower extremity arterial disease and a predictor of cardiovascular events. Little information is available on longitudinal change in ABI or on risk factors for declining ABI in a community-based population.

Methods  To assess risk factors for ABI decline, we studied 5888 participants in the Cardiovascular Health Study cohort (men and women 65 years or older). We measured ABI in 1992-1993 and again in 1998-1999. At baseline, we excluded individuals with an ABI less than 0.9, ABI greater than 1.4, or confirmed symptomatic lower extremity arterial disease (n = 823). The group with ABI decline included 218 participants with decline greater than 0.15 and to 0.9 or less. The comparison group comprised the remaining 2071 participants with follow-up ABI.

Results  The percentage of participants with ABI decline was 9.5% over 6 years of follow-up. The mean ± SD decline was 0.33 ± 0.12 in cases of ABI decline and 0.02 ± 0.13 in noncases. Independent predictors of ABI decline, reported as odds ratios, were age, 1.96 (95% confidence interval [CI], 1.42-2.71) for 75 to 84 years and 3.79 (95% CI, 1.36-10.5) for those older than 85 years compared with those younger than 75 years; current cigarette use, 1.74 (95% CI, 1.02-2.96); hypertension, 1.64 (95% CI, 1.18-2.28); diabetes, 1.77 (95% CI, 1.14-2.76); higher low-density lipoprotein cholesterol level, 1.60 (95% CI, 1.03-2.51), and lipid-lowering drug use 1.74 (95% CI, 1.05-2.89).

Conclusion  Worsening lower extremity arterial disease, assessed as ABI decline, occurred in 9.5% of this elderly cohort over 6 years and was associated with modifiable vascular disease risk factors.

Author Affiliations: Department of Medicine, University of Vermont, Burlington (Drs Kennedy and Cushman); Department of Biostatistics, University of Washington, Seattle (Dr Solomon); Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, Bethesda, Md (Dr Manolio); Departments of Family and Preventive Medicine and Medicine, University of California, San Diego (Dr Criqui); Departments of Medicine and Epidemiology, University of Pittsburgh, Pittsburgh, Pa (Dr Newman); Department of Radiology, Tufts University School of Medicine, Boston, Mass (Dr Polak); Department of Public Health Sciences, Wake Forest University, Winston-Salem, NC (Dr Burke); and Respiratory Sciences Center, University of Arizona, Tucson (Dr Enright). Dr Kennedy is now with the Western Pennsylvania Cancer Institute, Western Pennsylvania Hospital, Pittsburgh.

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