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Measurement characteristics of the ankle-brachial index: results from the Action for Health in Diabetes study.

ABSTRACT: Many protocols have been used in clinical and research settings for collecting systolic blood pressure (SBP) measurements to calculate the ankle-brachial index (ABI); however, it is not known how useful it is to replicate measurements and which measures best reflect cardiovascular risk. Standardized measurements of ankle and arm SBP from 5140 overweight or obese individuals with type 2 diabetes were used to estimate sources of variation. Measurement characteristics of leg-specific ABI, as calculated using a standard algorithm based on the highest SBP of the dorsalis pedis or posterior tibial arteries, were projected using simulations. Coefficients of variability ranged from 2% to 3% when single SBP measurements were used and ABI was overestimated by 2-3%. Taking two SBP measurements at each site reduced standard errors and bias each by 30-40%. The sensitivity of detecting low ABI ranges exceeded 90% for ABI within 0.05 of the 0.90 clinical cut-point. The average and the minimum of the two (i.e. right and left) leg-specific ABI values had similar U-shaped relationships with Framingham risk scores; however, the average leg ABI had slightly greater precision. Replicating SBP measurements reduces the error and bias of ABI. Averaging leg-specific values may increase power for characterizing cardiovascular disease risk.

SUBMITTER: Espeland MA

PROVIDER: S-EPMC2713116 | biostudies-literature | 2008 Aug

REPOSITORIES: biostudies-literature

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Measurement characteristics of the ankle-brachial index: results from the Action for Health in Diabetes study.

Espeland Mark A MA Regensteiner Judith G JG Jaramillo Sarah A SA Gregg Edward E Knowler William C WC Wagenknecht Lynne E LE Bahnson Judy J Haffner Steven S Hill James J Hiatt William R WR

Vascular medicine (London, England) 20080801 3

Many protocols have been used in clinical and research settings for collecting systolic blood pressure (SBP) measurements to calculate the ankle-brachial index (ABI); however, it is not known how useful it is to replicate measurements and which measures best reflect cardiovascular risk. Standardized measurements of ankle and arm SBP from 5140 overweight or obese individuals with type 2 diabetes were used to estimate sources of variation. Measurement characteristics of leg-specific ABI, as calcul ...[more]

PMID: 18687759

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Project description:BACKGROUND:Sleep apnea and diabetes mellitus (DM) negatively impact cardiovascular health. One important indicator of cardiovascular health is the Ankle-Brachial Index (ABI). Either low ABI or high ABI are signs of peripheral vascular impairment. Impaired vascular health and DM, together, might provoke sleep apnea; however, information regarding these relationships is limited. Therefore, this study aimed to investigate the association between ABI, DM status, and severity of obstructive sleep apnea in people of Hispanic/Latino descent who are diverse in culture, environmental exposures, nativity, socioeconomic status, and disease burden. METHODS:A cross sectional analysis from a multi-center epidemiologic study, Hispanic Community Health Study/Study of Latinos, was utilized and included 3779 participants (mean age 55.32?±?7.67, females 57.9%). The sample was divided into 4 groups based on the American Diabetes Association diagnostic guidelines (no DM or DM), and the ABI status (normal and abnormal). Multiple linear regression analysis was used to determine the association of the four groups and other independent variables with severity of sleep apnea measured by apnea-hypopnea index. Kruskal-Wallis H test was used for comparisons between groups for the apnea-hypopnea index. The significant level was set at 0.01. RESULTS:There were significant differences between groups in the mean of apnea-hypopnea index (P?<?0.001; no DM?+?normal ABI?=?5.42?±?9.66, no DM?+?abnormal ABI?=?7.11?±?11.63, DM?+?normal ABI?=?10.99?±?15.16, DM?+?abnormal ABI?=?12.81?±?17.80). Linear regression showed that DM and abnormal ABI were significantly associated with severe sleep apnea (??=?3.25, P?=?0.001) after controlling for age, sex, BMI, income, education, alcohol use, cigarette use, hypertension or related medication, stroke and statin use. CONCLUSION:These findings suggest that people with DM and abnormal ABI were more likely to have high apnea-hypopnea index compared to the other groups. We observed gradual increasing in the severity of sleep apnea from low abnormality groups to high abnormality groups for Hispanic/Latino. Further work should elucidate the association of DM, abnormal ABI and sleep apnea with longer term outcomes, and replicate this work in different populations.

Dataset Information

Measurement characteristics of the ankle-brachial index: results from the Action for Health in Diabetes study.

Publications

Measurement characteristics of the ankle-brachial index: results from the Action for Health in Diabetes study.

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