Relationship between ankle-brachial index and age among 22 886 people undergoing health examination: a restricted cubic spline regression analysis_Chinese Journal of Evidence-Based Medicine

Authors：

WU Qingmeng ¹ , TANG Lan ² , Sun Rong ² , Zhong Li ² , Wang Xiaolin ² ,  PENG Bin ¹

1. School of Public Health and Management, Chongqing Medical University, Chongqing, 400016, P.R.China;
2. The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, P.R.China;

Corresponding?author：

PENG Bin, Email: Pengbin@cqmu.edu.cn

Keywords：

Ankle-brachial index; Age; Physical examination population; Cardiovascular disease; Logistic regression; Restricted cubic spline analysis

DOI：

10.7507/1672-2531.201809126

Video：

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ObjectivesTo investigate the level of ankle-brachial index (ABI) of health examination population in Chongqing municipality and analyze the risk factors related to the level of ABI, so as to provide basis for effective evaluation of atherosclerotic lesions and their severity, as well as early detection, intervention and treatment of clinical cardiovascular diseases. MethodsA total of 22 886 subjects aged from 20 to 85 undergoing health examination in the medical examination center of First Affiliated Hospital of Chongqing Medical University in Chongqing municipality from January to December in 2016 were retrospectively analyzed. ABI and related physiological and biochemical data were collected. The relationship between ABI and age was analyzed using stepwise logistic regression model combined with restricted cubic splines. ResultsThe detection rate of abnormal ABI was 3.31% in 22 886 subjects undergoing health examination with 2.90% in males and 3.92% in females. The subjects aged below 40 presented the highest detection rate of abnormal ABI (6.17%) with 4.72% in males and 8.66% in females. The subjects were divided into two groups, one with ABI≤0.9 and one with ABI>0.9; the differences in age and levels of body mass index (BMI), waist circumference (WC), systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), and low-density lipoprotein cholesterol (LDL-C) between the two groups were statistically significant (allP<0.05). Multivariate stepwise logistic regression combined with restricted cubic splines showed that age, gender and BMI were presented as independent factors affecting ABI, among which the age below 40 (OR=2.885, 95%CI (2.445, 3.404),P<0.0001) was the main risk factor. A curve relating age to probability of abnormal ABI was produced after correcting for the influences of sex and BMI, stratified by gender and BMI into different subgroups, showing a U-shaped curve of decreasing initially and then increasing between the probability of abnormal ABI and age. ConclusionsThe detection rate of abnormal ABI based on individuals undergoing health examination in Chongqing municipality was 3.31%. A U-shaped curve of downward trend followed by an upward one was shown between probability of abnormal ABI and age after correcting for the influences of gender and BMI. The clinical significance of ABI≤0.9 for youth population (20 to 40 years old) without cardiovascular risk factors requires further exploration.

Citation： WU Qingmeng, TANG Lan, Sun Rong, Zhong Li, Wang Xiaolin, PENG Bin. Relationship between ankle-brachial index and age among 22 886 people undergoing health examination: a restricted cubic spline regression analysis. Chinese Journal of Evidence-Based Medicine, 2018, 18(12): 1287-1291. doi: 10.7507/1672-2531.201809126 Copy

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19.	Sadeghi M, Heidari R, Mostanfar B, et al. The relation between ankle-brachial index (ABI) and coronary artery disease severity and risk factors: an angiographic study. ARYA Atheroscler, 2011, 7(2): 68.
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21.	Racalbu M, Iliuta L, Guberna SM, et al. The role of ankle-brachial index for predicting peripheral arterial disease. Maedica (Buchar), 2014, 9(3): 295.

1. Aboyans V, Criqui MH, Abraham P, et al. Measurement and interpretation of the Ankle-brachial index: a scientific statement from the American heart association. Circulation, 2012, 126(24): 2890.
2. Criqui MH, Mcclelland RL, Mcdermott MM, et al. The Ankle-brachial index and incident cardiovascular events in the multi-ethnic study of atherosclerosis (MESA). J Am Coll Cardiol, 2010, 56(18): 1506-1512.
3. Ankle Brachial Index Collaboration, Fowkes FG, Murray GD, et al. Ankle brachial index combined with Framingham Risk Score to predict cardiovascular events and mortality: a meta-analysis. JAMA, 2008, 300(2): 197-208.
4. 胡大一. 重視踝臂指數, 關注下肢外周動脈病. 中國醫藥導刊, 2005, 7(1): 29.
5. Xu D, Zou L, Xing Y, et al. Diagnostic value of ankle-brachial index in peripheral arterial disease: a meta-analysis. Can J Cardiol, 2013, 29(4): 492-498.
6. Alzamora MT, Forés R, Pera G, et al. Ankle-brachial index and the incidence of cardiovascular events in the mediterranean low cardiovascular risk population ARTPER cohort. BMC Cardiovasc Disord, 2013, 13(1): 119.
7. Fan H, Hu X, Yu W, et al. Low ankle-brachial index and risk of stroke. Atherosclerosis, 2013, 229(2): 317-323.
8. 蘆生芳, 于峰, 韓伏蒞, 等. 踝臂指數與缺血性腦卒中的關系. 同濟大學學報 (醫學版), 2013, 34(1): 81-84.
9. 李冰, 吳麗娜, 鄒世清, 等. 1551 例體檢人群脈搏波速度和踝臂指數檢測結果及影響因素分析. 武漢大學學報 (醫學版), 2012, 33(4): 532-537.
10. 張悅, 劉壯, 汪荷. 踝臂指數在體檢人群中的分布特征及其相關因素分析. 中國衛生統計, 2016, 33(2): 290-292.
11. Correction to: 2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Available at: https://www.ahajournals.org/doi/pdf/10.1161/CIR.0000000000000501.
12. 中華人民共和國衛生和計劃生育委員會. WS/T 428-2013 中華人民共和國衛生行業標準《成人體重判定》. 北京: 中國標準出版社, 2013.
13. 中國高血壓防治指南修訂委員會. 中國高血壓防治指南 2010. 中國醫學前沿雜志 (電子版), 2011, 3(5): 42-93.
14. 諸駿仁, 高潤霖, 趙水平, 等. 中國成人血脂異常防治指南 (2016 年修訂版). 中國循環雜志, 2016, 16(10): 15-35.
15. 中華醫學會糖尿病學分會. 中國 2 型糖尿病防治指南 (2013 年版). 中華內分泌代謝雜志, 2014, 30(10): 893-942.
16. Resnick HE, Lindsay RS, Mcdermott MM, et al. Relationship of high and low ankle brachial index to all-cause and cardiovascular disease mortality: the strong heart study. Circulation, 2004, 109(6): 733-739.
17. 王鳳娣, 徐勤, 黃英, 等. 體檢人群中踝臂指數特點分析. 內蒙古中醫藥, 2009, 28(24): 46-47.
18. 許長瑛, 王永紅. 體檢人群心踝血管指數和踝臂血管指數影響因素分析. 現代醫藥衛生, 2016, 32(2): 181-184.
19. Sadeghi M, Heidari R, Mostanfar B, et al. The relation between ankle-brachial index (ABI) and coronary artery disease severity and risk factors: an angiographic study. ARYA Atheroscler, 2011, 7(2): 68.
20. Moyer VA. Screening for peripheral artery disease and cardiovascular disease risk assessment with the ankle-brachial index in adults: U. S. Preventive Services Task Force recommendation statement. Ann Intern Med, 2014, 59(4): 342-348.
21. Racalbu M, Iliuta L, Guberna SM, et al. The role of ankle-brachial index for predicting peripheral arterial disease. Maedica (Buchar), 2014, 9(3): 295.

Chinese Journal of Evidence-Based Medicine

Relationship between ankle-brachial index and age among 22 886 people undergoing health examination: a restricted cubic spline regression analysis

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