MedWire News: Ankle–brachial blood pressure index (ABI) predicts cardiovascular (CV) risk and mortality in patients with ischemic stroke or transient ischemic attack (TIA), research indicates.
The results suggest that ABI may be useful for risk-stratifying stroke patients and targeting secondary prevention efforts, in addition to its established role as a CV risk marker in the general population.
For the study, Markus Busch (Robert Koch Institute, Berlin, Germany) and team recruited 204 consecutive patients admitted to hospital with acute ischemic stroke or TIA. The patients were assessed for ABI and other CV risk factors at baseline and then followed-up for a mean of 2.3 years.
In all, 63 (31%) patients had a low ABI, defined as a value ≤0.9. These individuals were more likely than others to be older, current smokers, and have hypertension, peripheral arterial disease, and cervical or intracranial stenosis.
The vast majority of patients with a low ABI were previously undiagnosed or asymptomatic, the researchers remark.
A total of 37 patients experienced a stroke, myocardial infarction (MI), or death during follow-up, equivalent to an event rate of 8.2% per person–year. The rate was significantly higher among individuals with a low baseline ABI, at 12.8% versus 6.3% in those with a normal ABI.
After adjusting for age and stroke etiology, a low ABI was associated with a two-fold increased risk for stroke, MI, or death, Busch et al report in the journal Stroke. This finding remained statistically significant, with a hazard ratio of between 2.1 and 2.3, after adjusting for established CV risk factors and CV comorbidities.
The researchers conclude that measuring ABI may help to identify patients with stroke or TIA who are at increased CV risk beyond established risk markers and who could potentially benefit from targeted, intensified, secondary prevention efforts.
Moreover, they suggest that ABI measurement may be useful for facilitating risk education and to increase risk awareness, potentially improving medication adherence and participation in “healthy lifestyle” programs.
However they add: “Before the value of a targeted approach to stroke prevention can be tested in intervention trials, further evaluation is required of the potential of incorporating ABI measurement in risk scores and risk-stratification systems on which secondary prevention strategies are based.”
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