Clinical Value of the Ankle-Brachial Index in Patients at Risk of Cardiovascular Disease but Without Known Atherothrombotic Disease: VITAMIN Study

Introduction and objectivesDetecting peripheral arterial disease by measuring the ankle-brachial index can help identify asymptomatic patients with established disease. We investigated the prevalence of peripheral arterial disease (i.e., an ankle-brachial index <0.9) and its potential clinical and therapeutic impact in patients with no known arterial disease who were seen at internal medicine departments.MethodsThis multicenter, cross-sectional, observational study included patients at risk of cardiovascular disease who were selected on the basis of age, gender and the presence of conventional risk factors. No patient was known to have arterial disease.ResultsThe study included 493 patients, 174 (35%) of whom had diabetes, while 321 (65%) did not. Only 16% were in a low-risk category according to their Framingham score. An ankle-brachial index <0.9 was observed in 27.4%, comprising 37.9% of those with diabetes and 21.3% of those without. Multiple logistic regression analysis showed that the risk factors associated with an ankle-brachial index <0.9 were age, diabetes, and hypercholesterolemia.There was a significant relationship between the ankle-brachial index and Framingham risk categories. Therapeutically, only 21% of patients with an ankle-brachial index <0.9 were taking antiplatelet drugs. Overall, 20% had a low-density lipoprotein cholesterol concentration <100 mg/dL and 52% had a concentration <130 mg/dL. Some 42% had arterial blood pressures below 140/90 mm Hg.ConclusionsAsymptomatic peripheral arterial disease was detected in a high proportion of patients with an intermediate or high cardiovascular disease risk. The ankle-brachial index should be measured routinely in patients at risk of cardiovascular disease who are seen at internal medicine departments.

Introducción y objetivosLa detección de la enfermedad arterial periférica, mediante el índice tobillo-brazo, permite identificar a los pacientes asintomáticos con una lesión establecida. Investigamos la prevalencia de enfermedad arterial periférica (índice tobillo-brazo < 0,9) en sujetos sin enfermedad arterial conocida atendidos en el ámbito de medicina interna y su potencial impacto clínico-terapéutico.MétodosEstudio multicéntrico, transversal, observa-cional en el que se incluyó a pacientes con potencial ries-go cardiovascular, seleccionados en función de la edad, el sexo y la presencia de factores de riesgo convenciona-les, pero sin enfermedad arterial conocida.ResultadosSe evaluaron 493 casos, de los que 174 eran diabéticos (35%) y 321, no diabéticos (65%). Sólo un 16% presentó un riesgo bajo según la ecuación de Framingham. Del total de la muestra, el índice tobillo-bra-zo fue < 0,9 en el 27,4% (el 37,9% de los diabéticos y el 21,3%, de los no diabéticos). En el análisis multivariable, los parámetros que se asociaron con un índice tobillo-brazo < 0,9 fueron la edad, la diabetes mellitus y la hiper-colesterolemia. Se objetivó una relación significativa en-tre las categorías de riesgo de Framingham y el índice tobillo-brazo. Al considerar a los pacientes con un índice tobillo-brazo < 0,9, sólo el 21% recibía tratamiento antia-gregante, el 20% presentaba valores de colesterol unido a lipoproteínas de baja densidad (LDL) < 100 mg/dl (el 52% con LDL < 130 mg/dl) y el 42% tenía unos valores de presión arterial < 140/90 mmHg.ConclusionesEn una proporción elevada de pacientes con riesgo cardiovascular intermedio o alto se detecta enfermedad arterial periférica asintomática. El índice tobillo-brazo debería medirse sistemáticamente en enfermos con riesgo vascular, evaluados en el ámbito de la medicina interna.