• J Woo and J Leung.
• Medicine and Therapeutics, Prince of Wales Hospital, Shatin, Hong Kong, China. jeanwoowong@cuhk.edu.hk
• Intern Med J. 2013 Sep 1; 43 (9): 101710231017-23.

Background/AimsThis study examined whether ankle-brachial index (ABI) is predictive of all-cause mortality, cardiovascular mortality, hospital admission for stroke, ischaemic heart disease or myocardial infarction among older people aged 65 years and above, and whether the inclusion of ABI in prediction models adds any incremental value to traditional cardiovascular risk factors.MethodsFour thousand men and women living in the community aged 65 years and over were recruited. ABI was measured, and information regarding comorbidity, smoking habit, physical activity and physical limitation was obtained at baseline. Hospital admissions for stroke and ischaemic heart disease/myocardial infarction were documented after a mean period of 6.0 years and mortality after a mean of 9.1 years.ResultsABI <0.9 alone was predictive of all outcomes with the exception of hospital admission for stroke. Inclusion of ABI in a model that includes other 'traditional' cardiovascular risk factors such as age; physical activity scale of the elderly; history of hypertension and other cardiovascular diseases, diabetes and smoking; and systolic blood pressure >140/90 reduced the hazard ratios but did not alter the overall results. Comparison of prediction models with and without ABI showed little difference. When different values of ABI were examined for all outcomes, values between 0.9 and 1.0 had high specificity but low sensitivity.ConclusionABI measurement (<0.9) predicted adverse outcomes with high specificity but low sensitivity. However, it added little incremental value to prediction of adverse outcomes using traditional cardiovascular risk factors.© 2013 The Authors; Internal Medicine Journal © 2013 Royal Australasian College of Physicians.

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