Article

Low ankle-brachial index (ABI) is a predictor of increased mortality.
The impact of a high ABI on mortality is less studied. Moreover, diabetes is
frequently associated with high ABI and, because of specific mechanisms in
diabetic vascular diseases, the relationship with prognosis may be unique.
Therefore, our aim was to compare mortality in individuals with and without
diabetes according to abnormally low and high ABI. METHODS: We studied
the association between ABI and all-cause and cardiovascular mortality in 6986
participants from the REACH registry, a cohort of 45 years and older stable
outpatients at high cardiovascular risk (2875 (41.1%) with diabetes) followed for
4 years. RESULTS: ABI was normal (0.91-1.29) in 49.5%, low (</=0.9) in 47.5%, and
high (>/=1.3) in 2.9% of participants. During follow up, 9.9% of participants
died (6.5% from cardiovascular causes). A low ABI was associated with
cardiovascular mortality (adjusted hazard ratio, HR, 1.98, 95% CI 1.62-2.41) and
all-cause mortality (HR 2.01, 95% CI 1.72-2.36), without heterogeneity according
to diabetes. In contrast, high ABI was associated with higher risk of all-cause
mortality in individuals with diabetes (HR 2.11, 95% CI 1.16-3.84), but not
without diabetes (HR 0.82, 95% CI 0.36-1.85; p-value for interaction 0.07). The
trend was similar for cardiovascular mortality (HR 2.13, 95% CI 1.03-4.44 and HR
1.05, 95% CI 0.43-2.59 with and without diabetes, respectively; p-value for
interaction 0.24). CONCLUSIONS: In the REACH registry, low ABI was associated
with mortality, similarly in individuals without and with diabetes, whereas the
association with high ABI was only observed in patients with diabetes.
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Langue : ANGLAIS