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J Atheroscler Thromb. 2014;21(9):966-73. Epub 2014 Apr 14.

A low ankle brachial index is associated with an increased risk of cardiovascular disease: the Hisayama study.

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  • 1Department of Environmental Medicine, Graduate School of Medical Sciences, Kyushu University.



Peripheral artery disease (PAD), defined as a decreased ankle brachial index (ABI), is a risk factor for cardiovascular disease; however, few studies have assessed the relationship between a low ABI and cardiovascular risks in Asian populations. We herein examined the relationship between the ABI and the development of cardiovascular disease in a Japanese community.


A total of 2,954community-dwelling Japanese individuals without prior cardiovascular disease ≥ 40years of age were followed up for an average of 7.1years. The subjects' ABIs were categorized into the three groups: low (≤0.90), borderline (0.91-0.99) and normal (1.00-1.40). We estimated the relationship between the ABI and cardiovascular risk using a Cox proportional hazards model.


During the follow-up period, 134subjects experienced cardiovascular events. The incidence of cardiovascular disease across the ABI values was significantly different (p<0.001). After adjusting for confounding factors, namely age, sex, systolic blood pressure, use of anti-hypertensive drugs, diabetes, total cholesterol, high-density lipoprotein cholesterol, obesity, smoking, alcohol intake and regular exercise, individuals with a low ABI were at 2.40-fold (95% confidence interval [CI] 1.14-5.06) greater risk of cardiovascular disease and 4.13-fold (95% CI 1.62-10.55) greater risk of coronary heart disease.


Our findings suggest that individuals with an ABI of ≤ 0.90 have an increased risk of cardiovascular events, independent from traditional risk factors, in the general Japanese population.

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