European Heart Journal Advance Access originally published online on September 4, 2006
European Heart Journal 2006 27(21):2580-2587; doi:10.1093/eurheartj/ehl228
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Association of ankle-brachial index and plaques in the carotid and femoral arteries with cardiovascular events and total mortality in a population-based study with 13 years of follow-up
1 Institute of Epidemiology, GSF—National Research Center for Environment and Health, Neuherberg, Germany
2 Institute of Information Management, Biometry, and Epidemiology, Ludwig-Maximilians-University of Munich, Munich, Germany
3 Division of Genetic Epidemiology, Department of Medical Genetics, Molecular and Clinical Pharmacology, Innsbruck Medical University, Innsbruck, Austria
4 Department of Vascular Surgery, Innsbruck Medical University, Innsbruck, Austria
5 Department of Internal Medicine II—Cardiology, University of Ulm Medical Center, Robert-Koch Strasse. 8, D-89081 Ulm, Germany
Received 3 May 2006; revised 3 August 2006; accepted 17 August 2006; online publish-ahead-of-print 4 September 2006.
* Corresponding author. Tel: +49 731 500 24441; fax: +49 731 500 33872. E-mail address: wolfgang.koenig{at}medizin.uni-ulm.de
See page 2495 for the editorial comment on this article (doi:10.1093/eurheartj/ehl283)
Aims Peripheral arterial occlusive disease is associated with a high risk of cardiovascular morbidity and mortality. We prospectively examined the association of the ankle-brachial index (ABI) and arterial plaques in carotid and femoral arteries with incident myocardial infarctions (MIs) and cardiovascular and total mortality in 1325 participants of the population-based MONICA Augsburg Survey 1989/90.
Methods and results At baseline, 6.1% of men and 2.6% of women had an ABI 
0.9. At least one plaque in the carotid or femoral arteries was identified in 51.8% of men and 36.3% of women. During a 13-year follow-up, 58 persons (4.4%) suffered a MI before age 75 and 189 persons (14.3%) died, 86 (6.5%) of them from cardiovascular causes. Kaplan–Meier curves confirmed both measurements as strong predictors for all three endpoints (P<0.0001). Cox regression analysis revealed an increase of the risk for MI and cardiovascular and total mortality of 22 (P=0.012), 35, and 32% (P<0.00001), respectively, per 0.1 unit decrease in ABI. Correction for measurement error in ABI increased these estimates. The increase in risk for MI and cardiovascular and total mortality was 52, 70, and 45%, respectively, for each increase in the number of plaque-affected arteries (P<0.0001).
Conclusion Both ABI and number of plaque-affected arteries are strong predictors for incident MI and cardiovascular and total mortality.
Key Words: Ankle-brachial index • Subclinical atherosclerosis • Acute coronary events • Total mortality • Prospective cohort • Population-based study
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