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Int J Stroke. 2015 Jun;10(4):589-93. doi: 10.1111/ijs.12450. Epub 2015 Jan 12.

The association of ankle-brachial index with silent cerebral small vessel disease: results of the Atahualpa Project.

Author information

1
School of Medicine, Universidad Espíritu Santo, Guayaquil, Ecuador.
2
School of Medicine, Stony Brook University, New York, NY, USA.
3
Gastroenterology Department, Vanderbilt University, Nashville, TN, USA.
4
Imaging Department, Hospital-Clínica Kennedy, Guayaquil, Ecuador.
5
Community Center, the Atahualpa Project., Atahualpa, Ecuador.
6
Cardiovascular Division, Washington University School of Medicine, St. Louis, MO, USA.

Abstract

BACKGROUND:

An abnormal ankle-brachial index has been associated with overt stroke and coronary heart disease, but little is known about its relationship with silent cerebral small vessel disease.

AIM:

To assess the value of ankle-brachial index as a predictor of silent small vessel disease in an Ecuadorian geriatric population.

METHODS:

Stroke-free Atahualpa residents aged ≥60 years were identified during a door-to-door survey. Ankle-brachial index determinations and brain magnetic resonance imaging were performed in consented persons. Ankle-brachial index ≤0.9 and ≥1.4 were proxies of peripheral artery disease and noncompressible arteries, respectively. Using logistic regression models adjusted for age, gender, and cardiovascular health status, we evaluated the association between abnormal ankle-brachial index with silent lacunar infarcts, white matter hyperintensities, and cerebral microbleeds.

RESULTS:

Mean age of the 224 participants was 70 ± 8 years, 60% were women, and 80% had poor cardiovascular health status. Ankle-brachial index was ≤0.90 in 37 persons and ≥1.4 in 17. Magnetic resonance imaging showed lacunar infarcts in 27 cases, moderate-to-severe white matter hyperintensities in 47, and cerebral microbleeds in 26. Adjusted models showed association of lacunar infarcts with ankle-brachial index ≤ 0.90 (OR: 3.72, 95% CI: 1.35-10.27, P = 0.01) and with ankle-brachial index ≥ 1.4 (OR: 3·85, 95% CI: 1.06-14.03, P = 0.04). White matter hyperintensities were associated with ankle-brachial index ≤ 0.90 (P = 0.03) and ankle-brachial index ≥ 1.4 (P = 0.02) in univariate analyses. There was no association between ankle-brachial index groups and cerebral microbleeds.

CONCLUSIONS:

In this population-based study conducted in rural Ecuador, apparently healthy individuals aged ≥60 years with ankle-brachial index values ≤0.90 and ≥1.4 are almost four times more likely to have a silent lacunar infarct. Ankle-brachial index screening might allow recognition of asymptomatic people who need further investigation and preventive therapy.

KEYWORDS:

ankle-brachial index; cerebral small vessel disease; peripheral artery disease; population-based study; silent lacunar strokes; white matter hyperintensities

PMID:
25580986
DOI:
10.1111/ijs.12450
[Indexed for MEDLINE]

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