To the Editor,

We would like to thank Valdivieso et al.1 for their interesting comments on the article by our ARTPER research group published in Revista Española de Cardiología.

With regard to a possible distortion of results caused by including patients with diabetes, we do not believe this constitutes an important limitation. The same could be said about the inclusion of patients with high blood pressure who, due to their higher cardiovascular risk, would also more frequently receive antihypertensive treatments and possibly–statins or antiplatelet agents. In fact, risk attributable to high blood pressure is greater than that of diabetes, as the magnitude of the effect does not differ excessively but prevalence is greater.2, 3

We agree that ankle-brachial index (ABI) measurement is of less clinical interest in low-risk than in intermediate-risk patients. Fortunately, there is a tool (REASON) that prioritizes ABI use, developed by the HERMES group and our own ARTPER group.4 To date, the Inter-society Consensus (TASC II) recommended measuring ABI in asymptomatic patients aged 50-69 years with diabetes or a history of smoking, at 70 years and older, and when cardiovascular risk is 10% to 20%.4 The REASON tool–which has been constructed and validated–establishes a score as a function of the risk factor profile to identify patients with a high probability of having ABI <0.9; it has 85.2% sensitivity, similar to TASC II, and 47.2% specificity, greater than TASC II (38.3%).4 How often ABI should be measured and/or repeated remains to be determined. This will require cohort follow-up studies and the consensus of groups of experts.

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Corresponding author: jbaena@imim.es