Highlights
- •Peripheral artery disease (PAD) association with mortality in native older Africans is poorly documented.
- •Low ABI (≤0.90) was associated with increased mortality risk in adults >=65 in Congo.
- •ABI may be a reliable tool to identify older people at high risk of death in Sub-Saharan Africa.
Abstract
Background and aims
Peripheral artery disease (PAD) is known to be associated with mortality in high income
countries but no data regarding Sub-Saharan Africa (SSA) populations are documented.
This study aimed at assessing the prognostic value of the Ankle Brachial Index (ABI)
among older adults in the Republic of Congo.
Methods
Congolese subjects ≥65 years were included in a longitudinal population-based survey
(EPIDEMCA-FU). Demographic, biological, and clinical data were collected at baseline.
PAD was defined by an ABI≤0.90. Information on mortality was collected from key informants
in participants' households. Cox proportional hazard models, adjusted for traditional
and cardiovascular risk factors, were fitted to evaluate the association between an
ABI≤0.90 and death.
Results
1029 participants were recruited at baseline. ABI measurement was obtained from 927
participants, of whom 17.4% presented an ABI≤0.90. During a 2-year follow-up, a total
of 83 (9.1%) deaths were recorded. Mortality was higher in the low-ABI group with
23 deaths (14.7%) vs. 57 (7.8%) and 3 (12.0%), respectively among those with 0.90 < ABI<1.4 and ABI≥1.40
(p = 0.039). After adjustment, an ABI≤0.90 was associated with an increased risk of
mortality (HR = 1.86; 95%CI 1.04–3.87). Mortality was also independently associated
with increasing age (HR = 1.05; 95%CI 1.02–1.09), dementia (HR = 2.73; 95% CI 1.15–8.05),
alcohol use (HR = 0.51; 95%CI 0.29–0.88) and female sex (HR = 0.37; 95%CI 0.19–0.72).
Conclusions
In this study, a low ABI predicted an increased mortality risk among older people.
ABI may represent a simple and inexpensive tool to identify older people at high risk
of death in SSA.
Graphical abstract
Graphical Abstract
Keywords
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Article Info
Publication History
Published online: May 16, 2019
Accepted:
May 9,
2019
Received in revised form:
April 15,
2019
Received:
April 4,
2018
Identification
Copyright
© 2019 Elsevier B.V. All rights reserved.
