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High ankle-brachial index and risk of cardiovascular or all-cause mortality: A meta-analysis

  • Xuyu Gu
    Affiliations
    Institute of Molecular Biology & Translational Medicine, The Affiliated People's Hospital, Jiangsu University, Zhenjiang, Jiangsu, 212002, China
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  • Changfeng Man
    Affiliations
    Institute of Molecular Biology & Translational Medicine, The Affiliated People's Hospital, Jiangsu University, Zhenjiang, Jiangsu, 212002, China
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  • Heng Zhang
    Affiliations
    Department of General Surgery, Nanjing Lishui District People's Hospital, Zhongda Hospital Lishui Branch, Southeast University, Nanjing, Jiangsu, 211200, China
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  • Yu Fan
    Correspondence
    Corresponding author. Institute of Molecular Biology & Translational Medicine, The Affiliated People's Hospital, Jiangsu University, No. 8 Dianli Road, 212002. Zhenjiang, China.
    Affiliations
    Institute of Molecular Biology & Translational Medicine, The Affiliated People's Hospital, Jiangsu University, Zhenjiang, Jiangsu, 212002, China
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      Highlights

      • Predictive values of abnormally high ankle-brachial index (ABI) for mortality are controversial.
      • High ABI is independently associated with an increased risk of all-cause mortality.
      • Routine measurement of ABI can identify persons who are at high risk of death.

      Abstract

      Background and aims

      Studies on high ankle-brachial index (ABI) to predict mortality risk have yielded conflicting results. This meta-analysis aimed to evaluate the association between abnormally high ABI and risk of cardiovascular or all-cause mortality.

      Methods

      Pubmed and Embase databases were systematically searched for relevant articles published up to August 15, 2018. Longitudinal observational studies that evaluated the association between abnormally high ABI at baseline and risk of cardiovascular or all-cause mortality were included. Pooled results were expressed as risk ratio (RR) with 95% confidence intervals (CI) for the abnormal high versus the reference normal ABI category.

      Results

      Eighteen studies enrolling 60,467 participants were included. Abnormally high ABI was associated with an increased risk of all-cause mortality (RR 1.50; 95% CI 1.27–1.77) and cardiovascular mortality (RR 1.84; 95% CI 1.54–2.20). The pooled RR of all-cause mortality was 1.45 (95% CI 1.16–1.82) for the general population, 1.67 (95% CI 1.03–2.71) for chronic kidney disease (CKD)/hemodialysis patients, and 1.55 (95% CI 1.10–2.20) for suspected or established cardiovascular disease (CVD) patients, respectively. The pooled RR of cardiovascular mortality was 1.84 (95% CI 1.43–2.38) for the general population, 4.28 (95% CI 2.18–8.40) for CKD/hemodialysis patients, and 1.58 (95% CI 1.22–2.05) for suspected or established CVD patients, respectively.

      Conclusions

      Abnormally high ABI is independently associated with an increased risk of all-cause mortality. However, interpretation of the association between abnormally high ABI and cardiovascular mortality should be done with caution because of the likelihood of publication bias.

      Graphical abstract

      Keywords

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      Linked Article

      • Comments on: “High ankle-brachial index and risk of cardiovascular or all-cause mortality: A meta-analysis”
        AtherosclerosisVol. 284
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          We read with great interest the recent updated article by Gu et al. suggesting high Ankle-Brachial Index (ABI) is independently associated with an increased risk of all-cause mortality [1]. The authors did a great work and we would like to congratulate them. However, we would like to comment on a few issues in the study that are important for clinicians dealing with this situation and expand on the pooled analysis using the same data included in the current paper. We would like to emphasize some important points about this well-written study.
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