Relationships between ankle brachial indexes and asymptomatic intracranial arterial stenosis in a Chinese community-based population
ZHANG Shufeng1, ZHANG Qian2,and ZHAO Xingquan2
1.Department of Neurology, General Hospital of Chinese People’s Armed Police Force, Beijing, 100039, China; 2.Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050,China
Abstract：Objective To study the relationships between the low ABI and asymptomatic intracranial artery stenosis (ICAS).Methods The current study involved 5206 participants. ICAS was assessed by Transcranial Doppler. ABI was defined and categorized according to the 2011 ACCF/AHA guideline: abnormal ABI(ABI≤0.90), borderline ABI( 0.91-0.99), normal ABI(1.00-1.40). Logistic regression analysis was used to study the association between a low ABI and the risk of ICAS.Results After adjustment for possible confounders, borderline ABI(OR=1.364, 95%CI:1.024-1.818) and abnormal ABI (OR=1.890,95%CI:1.345-2.658)were both found to be significantly related to asymptomatic ICAS in all the participants. Further subgroup analysis revealed that males with an abnormal ABI were more than twice (OR=2.143, 95%CI:1.419-3.235) as vulnerable to ICAS as those with a normal ABI,but not so in women. In participants aged 60 or above, borderline ABI and abnormal ABI were both associated with ICAS, and OR was 1.963(95%CI:1.252-3.079) and 2.771(95%CI:1.788-4.293) respectively.Conclusions ABI can be considered an index for assessment of risks of ICAS among asymptomatic people, but this association varies with age and gender.
Winsor T. Influence of arterial disease on the systolic blood pressure gradients of the extremity [J]. Am J Med Sci,1950,220:117-126.
[2]
Yao S T, Hobbs J T, Irvine W T. Ankle systolic pressure measurements in arterial disease affecting the lower extremities[J]. Br J Surg, 1969,56:676-679.
[3]
Carter S A. Indirect systolic pressures and pulse waves in arterial occlusive diseases of the lower extremities[J]. Circulation, 1968,37:624-637.
[4]
McDermott M M, Guralnik J M, Tian L, et al. Associations of borderline and low normal ankle-brachial index values with functional decline at 5-year follow-up: The walcs (walking and leg circulation study) [J]. J Am Coll Cardiol,2009, 53:1056-1062.
[5]
Fowkes F G, Murray G D, Butcher I, et al. Ankle brachial index combined with framingham risk score to predict cardiovascular events and mortality: A meta-analysis [J].JAMA, 2008, 300:197-208.
[6]
Criqui M H, Langer R D, Fronek A, et al. Mortality over a period of 10 years in patients with peripheral arterial disease[J]. New Engl J Med, 1992, 326:381-386.
[7]
Bouisset F, Bongard V, Ruidavets J-B, et al. Prognostic usefulness of clinical and subclinical peripheral arterial disease in men with stable coronary heart disease [J]. Am J Cardiol, 2012, 110:197-202.
[8]
Aboyans V, McClelland R L, Allison M A, et al. Lower extremity peripheral artery disease in the absence of traditional risk factors. The multi-ethnic study of atherosclerosis [J]. Atherosclerosis, 2011, 214:169-173.
[9]
Papamichael C M,Lekakis J P,Stamatelopoulos KS,et al. Ankle-brachial index as a predictor of the extent of coronary atherosclerosis and cardiovascular events in patients with coronary artery disease[J]. Am J Cardiol,2000, 86(6):615-618.
[10]
Hirsch A T, Haskal Z J, Hertzer N R, et al. ACCF/AHA 2005 practice guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): A collaborative report from the american association for vascular surgery/society for vascular surgery, society for cardiovascular angiography and interventions, society for vascular medicine and biology, society of interventional radiology, and the acc/aha task force on practice guidelines (writing committee to develop guidelines for the management of patients with peripheral arterial disease): Endorsed by the american association of cardiovascular and pulmonary rehabilitation; national heart, lung, and blood institute; society for vascular nursing; transatlantic inter-society consensus; and vascular disease foundation[J]. Circulation, 2006,113: e463-654.
[11]
Rooke T W, Hirsch A T, Misra S, et al. 2011 ACCF/AHA focused update of the guideline for the management of patients with peripheral artery disease (updating the 2005 guideline) [J]. J Am Coll Cardiol, 2011,58:2020-2045.
[12]
Diehm C, Allenberg J R, Pittrow D, et al. Mortality and vascular morbidity in older adults with asymptomatic versus symptomatic peripheral artery disease[J]. Circulation, 2009, 120:2053-2061.
[13]
Ankle Brachial Index Collaboration. Ankle brachial index combined with framingham risk score to predict cardiovascular events and mortality:a meta-analysis[J]. JAMA, 2008, 300:197-208.
[14]
Y Zhou, Y Li, L Xu, et al. Asymptomatic Polyvascular Abnormalities in Community (APAC) Study in China: objectives, design and baseline characteristics[J]. PLOS ONE, 2013, 8(12): e84685.
[15]
S Zhang, Y Zhou, Y Zhang, et al. Prevalence and risk factors of asymptomatic intracranial arterial stenosis in a community-based population of Chinese adults[J]. Eur J Neurol, 2013, 20: 1479-1485.
[16]
Wong K S, Huang Y N, Yang H B, et al. A door-to-door survey of intracranial atherosclerosis in liangbei county, china [J]. Neurology, 2007, 68: 2031-2034.
[17]
Aboyans V,Criqui M H,Abraham P,et al. Measurement and interpretation of the ankle-brachial index: a scientific statement from the American Heart Association[J]. Circulation,2012,126(24):2890-2909.
[18]
Razzouk L, Rockman C B, Patel M R, et al. Co-existence of vascular disease in different arterial beds: peripheral artery disease and carotid artery stenosis--Data from Life Line Screening (?)[J].Atherosclerosis, 2015, 241(2):687-691.
[19]
Jiménez M, Dorado L, Hernández-Pérez M, et al. Ankle-brachial index in screening for asymptomatic carotid and intracranial atherosclerosis [J]. Atherosclerosis, 2014, 233(1):72-75.
[20]
Watanabe M, Kimura K, Iguchi Y, et al. Peripheral arterial atherosclerosis in patients with extracranial, not intracranial, arterial stenosis[J]. Internal Med, 2010,49:1515-1519.
[21]
Tsai A W, Folsom A R, Rosamond W D, et al. Ankle-brachial index and 7-year ischemic stroke incidence: The aric study[J]. Stroke, 2001,32:1721-1724.
[22]
McDermott M M. Ankle-brachial index and subclinical cardiac and carotid disease: the multi-ethnic study of atherosclerosis[J]. Am J Epidemiol, 2005,162:33-41.
[23]
Menke A, Muntner P, Wildman R P, et al. Relation of borderline peripheral arterial disease to cardiovascular disease risk [J]. Am J Cardiol, 2006, 98(9): 1226-1230.
[24]
Savji N,Rockman C B,Skolnick A H,et al.Association between advanced age and vascular disease in different arterial territories: a population database of over 3.6 million subjects [J]. J Am Coll Cardiol, 2013, 61(16):1736-1743.
[25]
Weatherley B D, Nelson J J, Heiss G, et al. The association of the ankle-brachial index with incident coronary heart disease: the Atherosclerosis Risk In Communities (ARIC) study, 1987-2001[J]. BMC Cardiovasc Diso, 2007, 7:3.
[26]
Murphy T P, Dhangana R, Pencina M J, et al. Ankle-brachial index and cardiovascular risk prediction: an analysis of 11,594 individuals with 10-year follow up[J]. Atherosclerosis, 2012, 220(1):160-167.
[27]
Tsai A W, Folsom A R, Rosamond W D, et al. Ankle-brachial index and 7-year ischemic stroke incidence: the ARIC study [J]. Stroke, 2001, 32(8):1721-1724.
[28]
Hirsch A T,Criqui M H,Treat-Jacobson D,et al. Peripheral arterial disease detection,awareness, and treatment in primary care[J]. JAMA,2001,286(11):1317-1324.
2017, Vol. 28 
