Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2006;59:662-70 - Vol. 59 Num.07 DOI: 10.1016/S1885-5857(07)60025-5

Clinical Value of the Ankle-Brachial Indexin Patients at Risk of Cardiovascular Disease but Without Known Atherothrombotic Disease: VITAMIN Study

Luis Manzano a, Juan de D García-Díaz b, Jorge Gómez-Cerezo c, Javier Mateos d, Francisco J del Valle e, Jesús Medina-Asensio e, Luis F Viejo f, Ángel Fernández-Ballesteros g, Javier Solís g, Almudena Herrero Domingo h, Eva Ferreira h, Demetrio Sánchez-Fuentes i, José M Barragán i, Julio González-Moraleja j, Juan A Vargas k, Manuel López-Jiménez l, Javier Zamora m

a 1. Lewis T, Feil HS, Stroud WD. Observations upon flutter and fibrillation. II: The nature of auricular flutter. Heart. 1920;7:191-245.
b Servicio de Medicina Interna, Hospital Universitario Príncipe de Asturias, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain.
c Servicio de Medicina Interna, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, Spain.
d Servicio de Medicina Interna, Hospital Universitario de Guadalajara, Guadalajara, Spain
e Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, Spain.
f Servicio de Medicina Interna, Hospital Provincial de Toledo, Toledo, Spain.
g Servicio de Medicina Interna, Hospital Severo Ochoa, Leganés, Madrid, Spain.
h Servicio de Medicina Interna, Hospital General de Segovia, Segovia, Spain.
i Servicio de Medicina Interna, Hospital Nuestra Señora de Sonsoles, Ávila, Spain
j Servicio de Medicina Interna, Hospital Virgen de la Salud, Toledo, Spain.
k Servicio de Medicina Interna, Hospital Universitario Puerta de Hierro, Universidad Autónoma de Madrid, Madrid, Spain.
l Servicio de Medicina Interna, Hospital de Móstoles, Madrid, Spain.
m Unidad de Bioestadística, Hospital Universitario Ramón y Cajal, Madrid, Spain, Red RMBE.

Keywords

Peripheral arterial disease. Ankle-brachial index. Atherosclerosis. Risk factors. Diabetes mellitus.

Abstract

Introduction and objectives. Detecting peripheral arterial disease by measuring the ankle-brachial index can help identify asymptomatic patients with established disease. We investigated the prevalence of peripheral arterial disease (i.e., an ankle-brachial index <0.9) and its potential clinical and therapeutic impact in patients with no known arterial disease who were seen at internal medicine departments. Methods. This multicenter, cross-sectional, observational study included patients at risk of cardiovascular disease who were selected on the basis of age, gender and the presence of conventional risk factors. No patient was known to have arterial disease. Results. The study included 493 patients, 174 (35%) of whom had diabetes, while 321 (65%) did not. Only 16% were in a low-risk category according to their Framingham score. An ankle-brachial index <0.9 was observed in 27.4%, comprising 37.9% of those with diabetes and 21.3% of those without. Multiple logistic regression analysis showed that the risk factors associated with an ankle-brachial index <0.9 were age, diabetes, and hypercholesterolemia. There was a significant relationship between the ankle-brachial index and Framingham risk categories. Therapeutically, only 21% of patients with an ankle brachial index <0.9 were taking antiplatelet drugs. Overall, 20% had a low-density lipoprotein cholesterol concentration <100 mg/dl and 52% had a concentration <130 mg/dl. Some 42% had arterial blood pressures below 140/90 mm Hg. Conclusions. Asymptomatic peripheral arterial disease was detected in a high proportion of patients with an intermediate or high cardiovascular disease risk. The ankle-brachial index should be measured routinely in patients at risk of cardiovascular disease who are seen at internal medicine departments.

1885-5857/© 2006 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved

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