Abstract
Background
There are conflicting data on the relationship between peripheral arterial disease
(PAD) as defined by an ankle–brachial index (ABI) of <0.9 and stroke risk, and these prior data have largely focused on a single race or
gender. Furthermore, the association between subsequent ABIs above the established
0.9 threshold for PAD vs. stroke has not been studied. This study assessed stroke
occurrence across the full spectrum of ABI values among a broad cohort of stroke survivors.
Methods
Data from the National Health and Nutrition Examination Survey from 1999–2004, a nationally
representative sample of United States adults, were used to assess prevalence of PAD
as evidenced by ABI of <0.9, and to simultaneously identify the independent associations of ABI levels (<0.90, 0.90–0.99, 1.00–1.09, >1.3) with stroke prevalence.
Results
Among 6382 adults, 4602 (72%) had full and complete data of which 277 (6%) reported
stroke occurrence. Stroke survivors were older and more likely to have diabetes, hypertension,
coronary artery disease, elevated blood pressure and glycohemoglobin, than non-stroke
respondents. More subjects with ABI <0.9 vs. ≥0.9 had experienced a stroke (12.7% vs. 5.4%, p<0.001). Within the full ABI range, stroke presence rose with decreasing ABI (p=0.0013). After adjustment for potential confounders, only ABI <0.9 (OR 1.9, 95% CI=1.2–3.1) and 0.9–0.99 (OR 2.3, 95% CI=1.4–3.6) compared with the referent group (1.10–1.29) were significantly associated
with presence of stroke.
Conclusions
Data from this nationally representative cohort support an independent relationship
between established PAD and stroke occurrence, but also indicate that even borderline
PAD is strongly linked to stroke.
Keywords
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Article info
Publication history
Accepted:
August 13,
2008
Received in revised form:
August 12,
2008
Received:
June 10,
2008
Identification
Copyright
© 2008 Elsevier B.V. Published by Elsevier Inc. All rights reserved.
