Improved prediction of fatal myocardial infarction using the ankle brachial index in addition to conventional risk factors: Edinburgh Artery Study

Amanda Jane Lee, J. F. Price, M. J. Russell, F. B. Smith, M. C. W. vanWijk, F. G. Fowkes

Research output: Contribution to journalArticle

147 Citations (Scopus)

Abstract

Background-Prediction of major cardiovascular and cerebrovascular events using conventional risk factor models is limited. Noninvasive measures of subclinical atherosclerosis such as the ankle brachial index (ABI) could improve risk prediction and provide more focused primary prevention strategies. We wished to determine the added value of a low ABI in the prediction of long-term risk of cardiovascular and cerebrovascular events and death.

Methods and Results-In 1988, 1592 men and women 55 to 74 years of age were randomly selected from the age-sex registers of 11 general practices in Edinburgh, Scotland, and followed up over a period of 12 years for incident events. After adjustment for age and sex, an ABIless than or equal to0.9 was predictive of an increased risk of fatal myocardial infarction (MI), cardiovascular death, all-cause death, combined fatal and nonfatal MI, and total cardiovascular events. After further adjustment for prevalent cardiovascular disease, diabetes, and conventional risk factors, a low ABI was independently predictive of the risk of fatal MI. Addition of the ABI significantly (Pless than or equal to0.01) increased the predictive value of the model for fatal MI compared with a model containing risk factors alone. Comparison of areas under receiver operator characteristic curves confirmed that a model including the ABI discriminated marginally better than one without.

Conclusions-Addition of the ABI significantly improved prediction of fatal MI over and above that of conventional risk factors. We recommend that the ABI be incorporated into routine cardiovascular screening and that the potential of its inclusion into cardiovascular scoring systems ( with a view to improving their accuracy) now be examined.

Original languageEnglish
Pages (from-to)3075-3080
Number of pages5
JournalCirculation
Volume110
DOIs
Publication statusPublished - Oct 2004

Keywords

  • atherosclerosis
  • cardiovascular diseases
  • risk factors
  • epidemiology
  • CORONARY-HEART-DISEASE
  • PRESSURE INDEX
  • BLOOD-PRESSURE
  • ARM INDEX
  • MORTALITY
  • MEN
  • ATHEROSCLEROSIS
  • DIAGNOSIS
  • STROKE
  • WOMEN

Cite this

Improved prediction of fatal myocardial infarction using the ankle brachial index in addition to conventional risk factors: Edinburgh Artery Study. / Lee, Amanda Jane; Price, J. F.; Russell, M. J.; Smith, F. B.; vanWijk, M. C. W.; Fowkes, F. G.

In: Circulation, Vol. 110, 10.2004, p. 3075-3080.

Research output: Contribution to journalArticle

Lee, Amanda Jane ; Price, J. F. ; Russell, M. J. ; Smith, F. B. ; vanWijk, M. C. W. ; Fowkes, F. G. / Improved prediction of fatal myocardial infarction using the ankle brachial index in addition to conventional risk factors: Edinburgh Artery Study. In: Circulation. 2004 ; Vol. 110. pp. 3075-3080.
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abstract = "Background-Prediction of major cardiovascular and cerebrovascular events using conventional risk factor models is limited. Noninvasive measures of subclinical atherosclerosis such as the ankle brachial index (ABI) could improve risk prediction and provide more focused primary prevention strategies. We wished to determine the added value of a low ABI in the prediction of long-term risk of cardiovascular and cerebrovascular events and death.Methods and Results-In 1988, 1592 men and women 55 to 74 years of age were randomly selected from the age-sex registers of 11 general practices in Edinburgh, Scotland, and followed up over a period of 12 years for incident events. After adjustment for age and sex, an ABIless than or equal to0.9 was predictive of an increased risk of fatal myocardial infarction (MI), cardiovascular death, all-cause death, combined fatal and nonfatal MI, and total cardiovascular events. After further adjustment for prevalent cardiovascular disease, diabetes, and conventional risk factors, a low ABI was independently predictive of the risk of fatal MI. Addition of the ABI significantly (Pless than or equal to0.01) increased the predictive value of the model for fatal MI compared with a model containing risk factors alone. Comparison of areas under receiver operator characteristic curves confirmed that a model including the ABI discriminated marginally better than one without.Conclusions-Addition of the ABI significantly improved prediction of fatal MI over and above that of conventional risk factors. We recommend that the ABI be incorporated into routine cardiovascular screening and that the potential of its inclusion into cardiovascular scoring systems ( with a view to improving their accuracy) now be examined.",
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AU - Price, J. F.

AU - Russell, M. J.

AU - Smith, F. B.

AU - vanWijk, M. C. W.

AU - Fowkes, F. G.

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N2 - Background-Prediction of major cardiovascular and cerebrovascular events using conventional risk factor models is limited. Noninvasive measures of subclinical atherosclerosis such as the ankle brachial index (ABI) could improve risk prediction and provide more focused primary prevention strategies. We wished to determine the added value of a low ABI in the prediction of long-term risk of cardiovascular and cerebrovascular events and death.Methods and Results-In 1988, 1592 men and women 55 to 74 years of age were randomly selected from the age-sex registers of 11 general practices in Edinburgh, Scotland, and followed up over a period of 12 years for incident events. After adjustment for age and sex, an ABIless than or equal to0.9 was predictive of an increased risk of fatal myocardial infarction (MI), cardiovascular death, all-cause death, combined fatal and nonfatal MI, and total cardiovascular events. After further adjustment for prevalent cardiovascular disease, diabetes, and conventional risk factors, a low ABI was independently predictive of the risk of fatal MI. Addition of the ABI significantly (Pless than or equal to0.01) increased the predictive value of the model for fatal MI compared with a model containing risk factors alone. Comparison of areas under receiver operator characteristic curves confirmed that a model including the ABI discriminated marginally better than one without.Conclusions-Addition of the ABI significantly improved prediction of fatal MI over and above that of conventional risk factors. We recommend that the ABI be incorporated into routine cardiovascular screening and that the potential of its inclusion into cardiovascular scoring systems ( with a view to improving their accuracy) now be examined.

AB - Background-Prediction of major cardiovascular and cerebrovascular events using conventional risk factor models is limited. Noninvasive measures of subclinical atherosclerosis such as the ankle brachial index (ABI) could improve risk prediction and provide more focused primary prevention strategies. We wished to determine the added value of a low ABI in the prediction of long-term risk of cardiovascular and cerebrovascular events and death.Methods and Results-In 1988, 1592 men and women 55 to 74 years of age were randomly selected from the age-sex registers of 11 general practices in Edinburgh, Scotland, and followed up over a period of 12 years for incident events. After adjustment for age and sex, an ABIless than or equal to0.9 was predictive of an increased risk of fatal myocardial infarction (MI), cardiovascular death, all-cause death, combined fatal and nonfatal MI, and total cardiovascular events. After further adjustment for prevalent cardiovascular disease, diabetes, and conventional risk factors, a low ABI was independently predictive of the risk of fatal MI. Addition of the ABI significantly (Pless than or equal to0.01) increased the predictive value of the model for fatal MI compared with a model containing risk factors alone. Comparison of areas under receiver operator characteristic curves confirmed that a model including the ABI discriminated marginally better than one without.Conclusions-Addition of the ABI significantly improved prediction of fatal MI over and above that of conventional risk factors. We recommend that the ABI be incorporated into routine cardiovascular screening and that the potential of its inclusion into cardiovascular scoring systems ( with a view to improving their accuracy) now be examined.

KW - atherosclerosis

KW - cardiovascular diseases

KW - risk factors

KW - epidemiology

KW - CORONARY-HEART-DISEASE

KW - PRESSURE INDEX

KW - BLOOD-PRESSURE

KW - ARM INDEX

KW - MORTALITY

KW - MEN

KW - ATHEROSCLEROSIS

KW - DIAGNOSIS

KW - STROKE

KW - WOMEN

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DO - 10.1161/01.CIR.0000143102.38256.DE

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JO - Circulation

JF - Circulation

SN - 0009-7322

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