03948nas a2200385 4500008004100000022001400041245015000055210006900205260001300274300001100287490000700298520283000305653000903135653001003144653000803154653002103162653003303183653002803216653001103244653001103255653000903266653002603275653003303301653002803334653003003362653001703392100001703409700002003426700001703446700001303463700001503476700001703491700001803508856003603526 1993 eng d a0009-732200aAnkle-arm index as a marker of atherosclerosis in the Cardiovascular Health Study. Cardiovascular Heart Study (CHS) Collaborative Research Group.0 aAnklearm index as a marker of atherosclerosis in the Cardiovascu c1993 Sep a837-450 v883 a

BACKGROUND: Peripheral arterial disease measured noninvasively by the ankle-arm index (AAI) is common in older adults, largely asymptomatic, and associated with clinically manifest cardiovascular disease (CVD). The criteria for an abnormal AAI have varied in previous studies. To determine whether there is an inverse dose-response relation between the AAI and clinical CVD, subclinical disease, and risk factors, we examined the relation of the AAI to cardiovascular risk factors, other noninvasive measures of subclinical atherosclerosis using carotid ultrasound, echocardiography and electrocardiography, and clinical CVD.

METHODS AND RESULTS: The AAI was measured in 5084 participants > or = 65 years old at the baseline examination of the Cardiovascular Health Study. All subjects had detailed assessment of prevalent CVD, measures of cardiovascular risk factors, and noninvasive measures of disease. Participants were stratified by baseline clinical CVD status and AAI (< 0.8, > or = 0.8 to < 0.9, > or = 0.9 to < 1.0, > or = 1.0 to < 1.5). Analyses tested for a dose-response relation of the AAI with clinical CVD, risk factors, and subclinical disease. The cumulative frequency of a low AAI was 7.4% of participants < 0.8, 12.4% < 0.9, and 23.6% < 1.0. participants with an AAI < 0.8 were more than twice as likely as those with an AAI of 1.0 to 1.5 to have a history of myocardial infarction, angina, congestive heart failure, stroke, or transient ischemic attack (all P < .01). In participants free of clinical CVD at baseline, the AAI was inversely related to history of hypertension, history of diabetes, and smoking, as well as systolic blood pressure, serum creatinine, fasting glucose, fasting insulin, measures of pulmonary function, and fibrinogen level (all P < .01). Risk factor associations with the AAI were similar in men and women free of CVD except for serum total and low-density lipoprotein cholesterol, which were inversely associated with AAI level only in women. Risk factors associated with an AAI of < 1.0 in multivariate analysis included smoking (odds ratio [OR], 2.55), history of diabetes (OR, 3.84), increasing age (OR, 1.54), and nonwhite race (OR, 2.36). In the 3372 participants free of clinical CVD, other noninvasive measures of subclinical CVD, including carotid stenosis by duplex scanning, segmental wall motion abnormalities by echocardiogram, and major ECG abnormalities were inversely related to the AAI (all P < .01).

CONCLUSIONS: There was an inverse dose-response relation of the AAI with CVD risk factors and subclinical and clinical CVD among older adults. The lower the AAI, the greater the increase in CVD risk; however, even those with modest, asymptomatic reductions in the AAI (0.8 to 1.0) appear to be at increased risk of CVD.

10aAged10aAnkle10aArm10aArteriosclerosis10aBlood Pressure Determination10aCardiovascular Diseases10aFemale10aHumans10aMale10aMultivariate Analysis10aPeripheral Vascular Diseases10aPopulation Surveillance10aPredictive Value of Tests10aRisk Factors1 aNewman, A, B1 aSiscovick, D, S1 aManolio, T A1 aPolak, J1 aFried, L P1 aBorhani, N O1 aWolfson, S, K uhttps://chs-nhlbi.org/node/144102779nas a2200409 4500008004100000022001400041245010900055210006900164260001300233300001100246490000700257520166200264653000901926653001801935653003101953653001901984653002802003653001902031653001602050653001102066653001102077653000902088653001602097653001902113653001502132653003102147653001702178653001202195653002002207653001802227100001702245700001802262700002202280700001602302700001502318856003602333 1996 eng d a1079-564200aRisk factors for abdominal aortic aneurysms in older adults enrolled in The Cardiovascular Health Study.0 aRisk factors for abdominal aortic aneurysms in older adults enro c1996 Aug a963-700 v163 a

B-mode ultrasound examinations of the abdominal aorta were performed from 1990 to 1992 to evaluate the prevalence of abdominal aortic aneurysm (AAA) in a subgroup of the Pittsburgh cohort (656 participants, aged 65 to 90 years) of the Cardiovascular Health Study (CHS). In this pilot study, we evaluated various definitions of aneurysm and the reproducibility of the measurements. In year 5 (1992 to 1993) of the CHS, the entire cohort (4741 participants) was examined. AAA was defined as an infrarenal aortic diameter of > or= 3.0 cm, or a ratio of infrarenal to suprarenal diameter of > or= 1.2, or a history of AAA repair. For the entire CHS cohort, prevalence of aneurysms was 9.5% (451/4741) overall, with a prevalence among men of 14.2% (278/1956) and prevalence among women of 6.2% (173/2785). Variables significantly related to AAA were older age; male sex; history of angina, coronary heart disease, and myocardial infarction; lower ankle-arm blood pressure ratio; higher maximum carotid stenosis; greater intima-media thickness of the internal carotid artery; higher creatinine; lower HDL levels and higher LDL levels; and cigarette smoking. The study has documented the strong association of cardiovascular risk factors and measures of clinical and subclinical atherosclerosis and cardiovascular disease and prevalence of aneurysms. We used a definition that is more sensitive than previously reported (diameter or ratio), which allowed the detection of smaller aneurysms and possibly those at an earlier stage of development. Follow-up of this cohort may lead to new criteria for determining the risk factors for progression of aneurysms.

10aAged10aAnthropometry10aAortic Aneurysm, Abdominal10aBlood Pressure10aCardiovascular Diseases10aCohort Studies10aComorbidity10aFemale10aHumans10aMale10aMiddle Aged10aPilot Projects10aPrevalence10aReproducibility of Results10aRisk Factors10aSmoking10aUltrasonography10aUnited States1 aAlcorn, H, G1 aWolfson, S, K1 aSutton-Tyrrell, K1 aKuller, L H1 aO'Leary, D uhttps://chs-nhlbi.org/node/1459