The utility of the ABI value as a screening test for disseminated atherosclerosis
Karan Garg, Jeffrey S Berger, Glenn R Jacobowitz, Thomas S Maldonado, Mark A Adelman, Thomas S Riles, Frank J Veith, Caron B Rockman
NYU Langone Medical Center, New York, NY
Objectives: Cardiovascular disease is the leading cause of death in the United States; nevertheless, there are no optimal or universally accepted screening tests for disseminated atherosclerosis. Patients with peripheral artery disease (PAD) are at increased risk for having atherosclerosis in additional vascular territories. The goal of this study was to determine the utility of the ABI value to predict coronary artery disease (CAD), cerebrovascular disease (CVD), and carotid artery stenosis (CAS).
Methods: A database of 3,561,679 subjects who underwent vascular screening was used. PAD was defined as an ABI ≤ 0.9. CAS was diagnosed if either artery demonstrated ≥ 50% stenosis. CVD and CAD history was obtained from subject questionnaires. Correlation of decreasing ABI values with vascular disease in other territories was performed.
Results: PAD was present in 125,889 subjects (3.5%). PAD subjects were more likely to be >70 years (55.1% vs. 25.9%), male (66.2% vs. 62.2%), to have a smoking history (59.7% vs. 43%), hypertension (62.1% vs. 43.9%), diabetes (20.2% vs. 9.6%), and hypercholesterolemia (56.1% vs. 50.4%) than non-PAD subjects (P<0.001). PAD subjects were more likely to have CAS (17.5% vs. 3.4%), prior strokes (5.4% vs. 1.6%), prior TIA (8.1% vs. 3.2%), prior MI (10.3% vs. 3.6%), and prior coronary revascularization (14.8% vs. 4.9%) than non-PAD subjects (P<0.001). There was a statistically significant correlation between decreasing ABI value and an increased prevalence of CAS, CAD, and CVD (P<0.001) (Figure 1). For example, patients with an ABI between 0.41 and 0.60 had a 26.4% incidence of CAS, which increased to 34.9% for those with an ABI ≤ 0.4. Even patients with a minimally decreased ABI (0.81 – 0.9) had significantly increased rates of vascular disease in other territories when compared to patients with normal ABI’s.
Conclusions: The ABI value is directly and significantly associated with the prevalence of CAS, and with a history of CAD and CVD complications. These data support the use of the ABI as a non-invasive, inexpensive, easily reproducible screening tests which can reliably identify patients at increased risk for cerebrovascular and cardiovascular complications.
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