Objetivo La significación clínica del índice tobillo/brazo (IT/B) elevado y su asociación a enfermedad cardiovascular es controvertida. Nuestro objetivo fue evaluar la asociación entre la elevación basal del IT/B con el riesgo de mortalidad cardiovascular (MCV), mortalidad total (MT) y aumento de evento coronario mayor (ECM) tras 5 años de seguimiento en una población mediterránea.
Sujetos y métodos Estudio poblacional prospectivo de 614 varones entre 55 y 74 años sin enfermedad arterial periférica. Medición basal de factores de riesgo cardiovascular (FRCV) e IT/B categorizados. Las categorías de IT/B fueron: 0,9-1,24(A), 1,25-1,34(B), ≥ 1,35(C). Los ECM, la MCV y MT fueron evaluadas durante el seguimiento.
Resultados La distribución de los sujetos según su mayor IT/B fue: A = 441(71,8%), B = 113 (18,4%) y C = 60 (9,7%). En referencia al grupo A (IT/B normal), los sujetos del grupo B y C presentaban mayor prevalencia de hipertensión (p < 0,01), tabaquismo (p < 0,01) y colesterol elevado (p = 0,04), siendo similares otros FRCV evaluados. Tras 5 años de seguimiento, y ajustando por posibles factores confusores, el riesgo de MCV y MT para los sujetos del grupo B en relación al grupo A fue de 1,33 (0,48-3,6, p = 0,57) y 1,07 (0,55-2,08, p = 0,83), respectivamente, y para los del grupo C fue de 0,53 (0,07-4,02, p = 0,54) y 0,79 (0,28-2,22, p = 0,66). Las diferencias de riesgo de ECM entre los grupos tampoco fue significativa (p = 0,07 grupo B y p = 0,97 grupo C, respecto A).
Conclusiones En nuestro estudio, la elevación del IT/B se asocia con una mayor prevalencia de algunos FRCV, sin embargo, este hallazgo hemodinámico no parece asociarse con un riesgo independiente adicional de ECM o mortalidad en nuestro medio.
Objective The clinical significance of an increased ankle/brachial index (ABI) and its association with risk factors and cardiovascular disease has been subject of controversy. Our objective was to evaluate the association between an increased baseline ABI with the risk of cardiovascular mortality (CVM), total mortality (TM) and increased major coronary events (MCE) at 5 years of follow-up in a Mediterranean population.
Subjects and methods A prospective survey was conducted on 614 men between 55 and 74 years-old with no peripheral arterial disease and representative of an urban district near Barcelona (Spain). Baseline cardiovascular risk factors and categorised ABI were recorded. ABI categories were: 0.9-1.24 (A), 1.25-1.34 (B), ≥ 1.35 (C). MCE, mortality and their cause were evaluated during 5-years of follow-up.
Results The distribution of subjects according to their ABI was: A = 441 (71.8%), B = 113 (18.4%) and C = 60 (9.7%). The B and C group subjects had a higher prevalence of hypertension (P < .01), higher cholesterol plasma levels (P = .04) and smokers (P < 0.01) compared to the normal ABI group (A), with the other risk factors assessed being similar. At 5-year follow-up (mean 65 months), and after adjustment for confounding factors, CVM and TM risk for B subjects were 1.33 (0.48-3.6, P = .57) and 1.07 (0.55-2.08, P = .83) respectively, compared to the normal ABI group (A). For C subjects they were 0.53 (0.07-4.02, P = .54) and 0.79 (0.28-2.22, P = .66). There were no significant differences in MCE risk between ABI groups (P = .07 for B and P = 0.97 for C, related to A).
Conclusions In our study, an increased ABI is associated with a higher prevalence of some risk factors; however this haemodynamic finding does not seem to be associated with an additional independent risk of MCE or mortality in our setting.
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