Prevalence of symptomatic and asymptomatic peripheral arterial disease and the value of the ankle-brachial index to stratify cardiovascular risk

Eur J Vasc Endovasc Surg. 2009 Sep;38(3):305-11. doi: 10.1016/j.ejvs.2009.04.013. Epub 2009 Jun 10.


Objectives: To determine the prevalence of ankle-brachial index (ABI)<0.9 and symptomatic peripheral arterial disease (PAD), association with cardiovascular risk factors (CVRF), and impact of adding ABI measurement to coronary heart disease (CHD) risk screening.

Design: Population-based cross-sectional survey of 6262 participants aged 35-79 in Girona, Spain.

Methods: Standardized measurements (CVRF, ABI, 10-year CHD risk) and history of intermittent claudication (IC), CHD, and stroke were recorded. ABI<0.9 was considered equivalent to moderate-to-high CHD risk (> or =10%).

Results: ABI<0.9 prevalence was 4.5%. Only 0.62% presented low ABI and IC. Age, current smoker, cardiovascular disease, and uncontrolled hypertension independently associated with ABI<0.9 in both sexes; IC was also associated in men and diabetes in women. Among participants 35-74 free of cardiovascular disease, 6.1% showed moderate-to-high 10-year CHD risk; adding ABI measurement yielded 8.7%. Conversely, the risk function identified 16.8% of these participants as having 10-year CHD risk>10%. In participants 75-79 free of cardiovascular disease, the prevalence of ABI<0.9 (i.e., CHD risk> or =10%) was 11.9%.

Conclusions: ABI<0.9 is relatively frequent in those 35-79, particularly over 74. However, IC and CHD risk> or =10% indicators are often missing. Adding ABI measurement to CHD-risk screening better identifies moderate-to-high cardiovascular risk patients.

Publication types

  • Comment
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Ankle / blood supply*
  • Blood Pressure Determination*
  • Blood Pressure*
  • Brachial Artery / physiopathology*
  • Cardiovascular Diseases / epidemiology*
  • Cardiovascular Diseases / etiology
  • Cardiovascular Diseases / physiopathology
  • Cross-Sectional Studies
  • Female
  • Health Surveys
  • Humans
  • Intermittent Claudication / epidemiology
  • Intermittent Claudication / etiology
  • Intermittent Claudication / physiopathology
  • Male
  • Mass Screening / methods*
  • Middle Aged
  • Odds Ratio
  • Peripheral Vascular Diseases / complications
  • Peripheral Vascular Diseases / epidemiology*
  • Peripheral Vascular Diseases / physiopathology
  • Predictive Value of Tests
  • Prevalence
  • Risk Assessment
  • Risk Factors
  • Spain / epidemiology
  • Time Factors