Stroke risk prediction beyond classical risk factors: the role of the Ankle-Brachial Index.

摘要

Major cardio- and cerebrovascular events often occur in individuals without known preexisting cardiovascular disease. The prevention of such events, including the accurate identification of those at risk, remains a serious public health challenge [1]. Scoring equations to predict those at increased risk have been developed using cardiovascular risk factors, but they tend to overestimate the risk in low-risk populations and underestimate it in high-risk populations [2].Peripheral arterial disease (PAD) is increasingly recognized as a clinically important marker of atherosclerotic disease due to its association with cardiovascular disease incidence and mortality. Determination of the ankle-brachial index (ABI), which is the ratio of systolic pressure at the ankle to that in the arm, is quick, easy to measure and a noninvasive method used to establish the presence of PAD. A reduced ABI has been shown to identify patients at risk for cardiovascular events [3]. Patients with stroke or transient ischemic attack often had PAD. However, it is still unclear whether PAD is also a good predictor for future cerebrovascular disease. A recent meta-analysis demonstrated a pooled multivar-iate adjusted relative risk of 1.35 (95% confidence interval, CI, 1.10-1.65) for stroke in patients with an ABI <0.9 [3].