Work

Ankle–brachial index and incident heart failure with reduced versus preserved ejection fraction: The Multi-Ethnic Study of Atherosclerosis

Year: 2019

Type: article

Abstract: This study investigated the relationship between ankle–brachial index (ABI) and risk for heart failure with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF). ABI has previously been associated with mortality, cardiovascular disease (CVD), and overall HF but the relationship between ABI and risk of HF stratified by EF has not been well characterized. We analyzed data from 6553 participants (53% female; mean age 62 ± 10 years) enrolled in the Multi-Ethnic Study of Atherosclerosis (MESA) who were free of known clinical CVD/HF at baseline (2000–2002) and had baseline ABI measured. Participants were classified as low (≤ 0.90), borderline-low (0.91–1.00), normal (1.01–1.40), and high (> 1.40) ABI. Incident hospitalized HF was determined over a median follow-up of 14 years; we classified HF events ( n = 321) as HFrEF with EF < 50% ( n = 155, 54%) or HFpEF with EF ⩾ 50% ( n = 133, 46%). Low ABI was associated with incident HFrEF (hazard ratio (HR): 2.02, 95% CI 1.19–3.40, p = 0.01) and had no significant association with HFpEF (HR: 0.67, 95% CI 0.30–1.48, p = 0.32). Borderline-low and high ABI were not significantly associated with HFrEF or HFpEF. Cubic spline analyses showed association with both low and high ABI for HFrEF and high ABI for HFpEF. A 1 SD lower ABI (for ABI < 1.1) was associated with incident HFrEF in multivariable analysis (HR: 1.27, 95% CI 1.05–1.54) but was not significant after additionally adjusting for interim myocardial infarction (HR: 1.21, 95% CI 0.99–1.48). Low ABI was associated with higher risk for incident HFrEF but not HFpEF in persons free of known CVD. Future studies of a larger size are needed for high ABI analyses.

Source: Vascular Medicine

DOI: 10.1177/1358863x19870602

Authors: Sameer Prasada, Sanjiv J Shah, Erin D Michos, Joseph F Polak, Philip Greenland

Institutions: Northwestern University, Johns Hopkins University, Johns Hopkins Medicine, Tufts Medical Center

Language: English

Topic: Heart Failure Treatment and Management

Subfield: Cardiology and Cardiovascular Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: bronze

Funders: U.S. Department of Health and Human Services, National Institutes of Health, National Heart, Lung, and Blood Institute