Ankle brachial index values, leg symptoms, and functional performance among community-dwelling older men and women in the lifestyle interventions and independence for elders study

Mary M McDermott, William B Applegate, Denise E Bonds, Thomas W Buford, Timothy Church, Mark A Espeland, Thomas M Gill, Jack M Guralnik, William Haskell, Laura C Lovato, Marco Pahor, Carl J Pepine, Kieran F Reid, Anne Newman, Mary M McDermott, William B Applegate, Denise E Bonds, Thomas W Buford, Timothy Church, Mark A Espeland, Thomas M Gill, Jack M Guralnik, William Haskell, Laura C Lovato, Marco Pahor, Carl J Pepine, Kieran F Reid, Anne Newman

Abstract

Background: The prevalence and significance of low normal and abnormal ankle brachial index (ABI) values in a community-dwelling population of sedentary, older individuals is unknown. We describe the prevalence of categories of definite peripheral artery disease (PAD), borderline ABI, low normal ABI, and no PAD and their association with lower-extremity functional performance in the LIFE Study population.

Methods and results: Participants age 70 to 89 in the LIFE Study underwent baseline measurement of the ABI, 400-m walk, and 4-m walking velocity. Participants were classified as follows: definite PAD (ABI <0.90), borderline PAD (ABI 0.90 to 0.99), low normal ABI (ABI 1.00 to 1.09), and no PAD (ABI 1.10 to 1.40). Of 1566 participants, 220 (14%) had definite PAD, 250 (16%) had borderline PAD, 509 (33%) had low normal ABI, and 587 (37%) had no PAD. Among those with definite PAD, 65% were asymptomatic. Adjusting for age, sex, race, body mass index, smoking, and comorbidities, lower ABI was associated with longer mean 400-m walk time: (definite PAD=533 seconds; borderline PAD=514 seconds; low normal ABI=503 seconds; and no PAD=498 seconds [P<0.001]). Among asymptomatic participants with and without PAD, lower ABI values were also associated with longer 400-m walk time (P<0.001) and slower walking velocity (P=0.042).

Conclusion: Among older community-dwelling men and women, 14% had PAD and 49% had borderline or low normal ABI values. Lower ABI values were associated with greater functional impairment, suggesting that lower extremity atherosclerosis may be a common preventable cause of functional limitations in older people.

Clinical trial registration url: https://ichgcp.net/clinical-trials-registry/NCT01072500" title="See in ClinicalTrials.gov">NCT01072500.

Keywords: aging; exercise; peripheral vascular disease.

Figures

Figure 1.
Figure 1.
Age and sex adjusted least square mean values for 400‐meter walk time and 4‐m walking velocity among LIFE Study participants according to their ankle brachial index. *Analyses are adjusted for age and sex. P values shown above individual bars represent statistically significant differences between the ABI group indicated compared with participants with ABI of 1.10 to 1.40. ABI indicates ankle brachial index; LIFE, Lifestyle Interventions and Independence for Elders.
Figure 2.
Figure 2.
Fully adjusted least square mean values for 400‐m walk time and 4‐m walking velocity among LIFE Study participants according to their ABI. P values in the figure represent overall statistical significance across all ABI categories. *Analyses are adjusted for age, sex, race, body mass index, smoking, physical activity, and comorbidities. P values shown above individual bars represent statistically significant differences between the ABI group indicated compared with participants with ABI of 1.10 to 1.40. ABI indicates ankle brachial index; LIFE, Lifestyle Interventions and Independence for Elders.

References

    1. Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Borden WB, Bravata DM, Dai S, Ford ES, Fox CS, Franco S, Fullerton HJ, Gillespie C, Hailpern SM, Heit JA, Howard VJ, Huffman MD, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Magid D, Marcus GM, Marelli A, Batchar DB, McGuire DK, Mohler ER, Moy CS, Mussolino ME, Nichol G, Paynter NP, Schreiner PJ, Sorlie PD, Stein J, Turan TN, Virani SS, Wong ND, Woo D, Turner MB. Executive summary: heart disease and stroke statistics‐2013 update: a report from the American Heart Association. Circulation. 2013; 127:143-152
    1. Fung YC. In: Fung YC. (ed.). Blood flow in arteries: pressure and velocity waves in large arteries and the effects of geometric nonuniformity. In Biodynamics—Circulation. 1984New York, NY: Springer‐Verlag; 133-136
    1. Yao ST, Hobbs JT, Irvine WT. Ankle systolic pressure measurements in arterial disease affecting the lower extremities. Br J Surg. 1969; 56:676-679
    1. Ouriel K, Zarins CK. Doppler ankle pressure: an evaluation of three methods of expression. Arch Surg. 1982; 117:1297-1300
    1. Lijmer JG, Hunink MG, van den Dungen JJ, Loonstra J, Smit AJ. ROC analysis of noninvasive tests for peripheral arterial disease. Ultrasound Med Biol. 1996; 22:391-398
    1. McDermott MM, Greenland P, Liu K, Guralnik JM, Criqui MH, Dolan NC, Chan C, Celic L, Pearce WH, Schneider JR, Sharma L, Clark E, Gibson D, Martin GJ. Leg symptoms in peripheral arterial disease: associated clinical characteristics and functional impairment. JAMA. 2001; 286:1599-1606
    1. McDermott MM, Fried L, Simonsick E, Ling S, Guralnik JM. Asymptomatic peripheral arterial disease is independently associated with impaired lower extremity functioning: the Women's Health and Aging Study. Circulation. 2000; 101:1007-1012
    1. Aboyans V, Criqui MH, Abraham P, Allison MA, Creager MA, Diehm C, Fowkes FG, Hiatt WR, Jönsson B, Lacroix P, Marin B, McDermott MM, Norgren L, Pande RL, Preux PM, Stoffers HE, Treat‐Jacobson DAmerican Heart Association Council on Peripheral Vascular Disease; Council on Epidemiology and Prevention; Council on Clinical Cardiology; Council on Cardiovascular Nursing; Council on Cardiovascular Radiology and Intervention, and Council on Cardiovascular Surgery and Anesthesia Measurement and interpretation of the ankle‐brachial index: a scientific statement from the American Heart Association. Circulation. 2012; 126:2890-2909
    1. Ankle Brachial Index Collaboration Fowkes FG, Murray GD, Butcher I, Heald CL, Lee RJ, Chambless LE, Folsom AR, Hirsch AT, Dramaix M, deBacker G, Wautrecht JC, Kornitzer M, Newman AB, Cushman M, Sutton‐Tyrrell K, Fowkes FG, Lee AJ, Price JF, d'Agostino RB, Murabito JM, Norman PE, Jamrozik K, Curb JD, Masaki KH, Rodríguez BL, Dekker JM, Bouter LM, Heine RJ, Nijpels G, Stehouwer CD, Ferrucci L, McDermott MM, Stoffers HE, Hooi JD, Knottnerus JA, Ogren M, Hedblad B, Witteman JC, Breteler MM, Hunink MG, Hofman A, Criqui MH, Langer RD, Fronek A, Hiatt WR, Hamman R, Resnick HE, Guralnik J, McDermott MM. Ankle brachial index combined with Framingham Risk Score to predict cardiovascular events and mortality: a meta‐analysis. JAMA. 2008; 300:197-208
    1. McDermott MM, Liu K, Greenland P, Guralnik JM, Criqui MH, Chan C, Pearce WH, Schneider JR, Ferrucci L, Celic L, Taylor LM, Vonesh E, Martin GJ, Clark E. Functional decline in peripheral arterial disease: associations with the ankle brachial index and leg symptoms. JAMA. 2004; 292:453-461
    1. McDermott MM, Liu K, Criqui MH, Ruth K, Goff D, Saad MF, Wu C, Homma S, Sharrett AR. Ankle‐brachial index and subclinical cardiac and carotid disease: the Multi‐Ethnic Study of Atherosclerosis. Am J Epidemiol. 2005; 162:33-41
    1. Amoh‐Tonto CA, Malik AR, Kondragunta V, Ali Z, Kullo IJ. Brachial‐ankle pulse wave velocity is associated with walking distance in patients referred for peripheral arterial disease evaluation. Atherosclerosis. 2009; 206:173-178
    1. Watson NL, Sutton‐Tyrell K, Youk AO, Boudreau RM, Mackey RH, Simonsick EM, Rosano C, Hardy SE, Windham BG, Harris TB, Najjar SS, Lakatta EG, Atkinson HH, Johnson KC, Bauer DC, Newman ABHealth ABC Study Arterial stiffness and gait speed in older adults with and without peripheral arterial disease. Am J Hypertens. 2011; 24:90-95
    1. Fielding RA, Rejeski WJ, Blair S, Church T, Espeland MA, Gill TM, Guralnik JM, Hsu FC, Katula J, King AC, Kritchevsky SB, McDermott MM, Miller ME, Nayfield S, Newman AB, Williamson JD, Bonds D, Romashkan S, Hadley E, Pahor MLIFE Research Group The Lifestyle Interventions and Independence for Elders Study: design and methods. J Gerontol A Biol Sci Med Sci. 2011; 66:1226-1237
    1. Stewart AL, Verboncoeur CJ, McLellan BY, Gillis DE, Rush S, Mills KM, King AC, Ritter P, Brown BW, Jr, Bortz WM., II Physical activity outcomes of CHAMPS II: a physical activity promotion program for older adults. J Gerontol A Biol Sci Med Sci. 2001; 56:M65-M70
    1. Shadman R, Criqui MH, Bundens WP, Fronek A, Denenberg JO, Garnst AC, McDermott MM. Subclavian artery stenosis: prevalence, risk factors, and association with cardiovascular diseases. J Am Coll Cardiol. 2004; 44:618-623
    1. Guralnik JM, Ferrucci L, Pieper CF, Leveille SG, Markides KS, Ostir GV, Studenski S, Berkman LF, Wallace RB. Lower extremity function and subsequent disability: consistency across studies, predictive models, and value of gait speed compared with the short physical performance battery. J Gerontol A Biol Sci Med Sci. 2000; 55:M221-M231
    1. Guralnik JM, Ferrucci L, Simonsick E, Salive ME, Wallace RB. Lower extremity function in persons over 70 years as a predictor of subsequent disability. N Engl J Med. 1995; 332:556-561
    1. Newman AB, Simonsick EM, Naydeck BL, Boudreau RM, Kritchesvsky SB, Nevitt MC, Pahor M, Satterfield S, Brach JS, Studenski SA, Harris TB. Association of long‐distance corridor walk performance with mortality, cardiovascular disease, mobility limitation, and disability. JAMA. 2006; 295:2018-2026
    1. McDermott MM, Guralnik JM, Tian L, Ferrucci L, Liu K, Liao Y, Criqui MH. Baseline functional performance predicts the rate of mobility loss in persons with peripheral arterial disease. J Am Coll Cardiol. 2007; 50:974-982
    1. McDermott MM, Tian L, Liu K, Guralnik JM, Ferrucci L, Tan J, Pearce WH, Schneider JR, Criqui MH. Prognostic value of functional performance for mortality in patients with peripheral artery disease. J Am Coll Cardiol. 2008; 51:1482-1489
    1. Criqui MH, Denenberg JO, Bird CE, Fronek A, Klauber MR, Langer RD. The correlation between symptoms and non‐invasive test results in patients referred for peripheral arterial disease testing. Vasc Med. 1996; 1:65-71
    1. McDermott MM, Guralnik JM, Liu K, Ferrucci L, Liao Y, Sharma L, Criqui MH. Associations of borderline and low normal ankle‐brachial index values with functional decline at 5‐year follow‐up: the WALCS (Walking and Leg Circulation Study). J Am Coll Cardiol. 2009; 53:1056-1062
    1. McDermott MM, Ferrucci L, Guralnik JM, Dyer AR, Liu K, Pearce WH, Clark E, Liao Y, Criqui MH. The ankle‐brachial index is associated with the magnitude of impaired walking endurance among men and women with peripheral arterial disease. Vasc Med. 2010; 15:251-257
    1. Espeland MA, Regensteiner JG, Jaramillo SA, Gregg E, Knowler WC, Wagenknecht LE, Bahnson J, Haffner S, Hill J, Hiatt WRLook AHEAD Study Group Measurement characteristics of the ankle‐brachial index: results from the Action for Health in Diabetes study. Vasc Med. 2008; 13:225-233
    1. Perera S, Mody SH, Woodman RC, Studenski SA. Meaningful change and responsiveness in common physical performance measures in older adults. J Am Geriatr Soc. 2006; 54:743-749
    1. Kwon S, Perera S, Pahor M, Katula JA, King AC, Groessl EJ, Studenski SA. What is a meaningful change in physical performance? Findings from a clinical trial in older adults (the LIFE‐P Study). J Nutr Health Aging. 2009; 13:538-544

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