Advertisement

Ankle Brachial Index (ABI) predicts 2-year mortality risk among older adults in the Republic of Congo: The EPIDEMCA-FU study

  • Harielle Samba
    Affiliations
    INSERM, U1094, Tropical Neuroepidemiology, Limoges, France

    Univ. Limoges, UMR_S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, F-87000, Limoges, France
    Search for articles by this author
  • Maëlenn Guerchet
    Correspondence
    Corresponding author. INSERM, UMR_S U1094, Tropical Neuroepidemiology, Faculté de Médecine, 2 rue du Dr Marcland, 87025, Limoges cedex, France.
    Affiliations
    INSERM, U1094, Tropical Neuroepidemiology, Limoges, France

    Univ. Limoges, UMR_S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, F-87000, Limoges, France

    King's College London, Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF, United Kingdom
    Search for articles by this author
  • Bébène Ndamba-Bandzouzi
    Affiliations
    INSERM, U1094, Tropical Neuroepidemiology, Limoges, France

    Department of Neurology, Brazzaville University Hospital, Brazzaville, Congo
    Search for articles by this author
  • Gilles Kehoua
    Affiliations
    INSERM, U1094, Tropical Neuroepidemiology, Limoges, France

    Univ. Limoges, UMR_S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, F-87000, Limoges, France
    Search for articles by this author
  • Pascal Mbelesso
    Affiliations
    INSERM, U1094, Tropical Neuroepidemiology, Limoges, France

    Department of Neurology, Amitié Hospital, Bangui, Central African Republic
    Search for articles by this author
  • Ileana Desormais
    Affiliations
    INSERM, U1094, Tropical Neuroepidemiology, Limoges, France

    Univ. Limoges, UMR_S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, F-87000, Limoges, France

    Department of Vascular Medicine, Limoges University Hospital, Limoges, France
    Search for articles by this author
  • Victor Aboyans
    Affiliations
    INSERM, U1094, Tropical Neuroepidemiology, Limoges, France

    Univ. Limoges, UMR_S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, F-87000, Limoges, France

    Department of Cardiology, Limoges University Hospital, Limoges, France
    Search for articles by this author
  • Pierre-Marie Preux
    Affiliations
    INSERM, U1094, Tropical Neuroepidemiology, Limoges, France

    Univ. Limoges, UMR_S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, F-87000, Limoges, France

    CHU, CEBIMER, Limoges, France
    Search for articles by this author
  • Philippe Lacroix
    Affiliations
    INSERM, U1094, Tropical Neuroepidemiology, Limoges, France

    Univ. Limoges, UMR_S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, F-87000, Limoges, France

    Department of Vascular Medicine, Limoges University Hospital, Limoges, France
    Search for articles by this author

      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

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Atherosclerosis
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Dalal S.
        • Beunza J.J.
        • Volmink J.
        • Adebamowo C.
        • Bajunirwe F.
        • et al.
        Non-communicable diseases in sub-Saharan Africa: what we know now.
        Int. J. Epidemiol. 2011; 40: 885-901
        • Fowkes F.G.R.
        • Rudan D.
        • Rudan I.
        • Aboyans V.
        • Denenberg J.O.
        • et al.
        Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis.
        Lancet Lond. Engl. 2013; 382: 1329-1340
        • Doobay A.V.
        • Anand S.S.
        Sensitivity and specificity of the ankle-brachial index to predict future cardiovascular outcomes: a systematic review.
        Arterioscler. Thromb. Vasc. Biol. 2005; 25: 1463-1469
        • Espinola-Klein C.
        • Rupprecht H.J.
        • Bickel C.
        • Lackner K.
        • Savvidis S.
        • et al.
        Different calculations of ankle-brachial index and their impact on cardiovascular risk prediction.
        Circulation. 2008; 118: 961-967
        • Heald C.L.
        • Fowkes F.G.R.
        • Murray G.D.
        • Price J.F.
        Ankle Brachial Index Collaboration Risk of mortality and cardiovascular disease associated with the ankle-brachial index: systematic review.
        Atherosclerosis. 2006; 189: 61-69
        • Diehm C.
        • Lange S.
        • Darius H.
        • Pittrow D.
        • von Stritzky B.
        • et al.
        Association of low ankle brachial index with high mortality in primary care.
        Eur. Heart J. 2006; 27: 1743-1749
        • Mensah G.A.
        • Roth G.A.
        • Sampson UkA.
        • Moran A.E.
        • Feigin V.L.
        • et al.
        Mortality from cardiovascular diseases in sub-Saharan Africa, 1990-2013: a systematic analysis of data from the Global Burden of Disease Study 2013.
        Cardiovasc. J. Afr. 2015; 26: S6-S10
        • Vogt M.T.
        • Wolfson S.K.
        • Kuller L.H.
        Lower extremity arterial disease and the aging process: a review.
        J. Clin. Epidemiol. 1992; 45: 529-542
        • Guerchet M.
        • Aboyans V.
        • Nubukpo P.
        • Lacroix P.
        • Clement J.P.
        • et al.
        Ankle Brachial Index as a marker of cognitive impairment and dementia in general population: a systematic review.
        Artherosclerosis. 2011; 2: 251-257
        • Lin J.S.
        • Olson C.M.
        • Johnson E.S.
        • Whitlock E.P.
        The ankle-brachial index for peripheral artery disease screening and cardiovascular disease prediction among asymptomatic adults: a systematic evidence review for the U.S. Preventive Services Task Force.
        Ann. Intern. Med. 2013; 159: 333-341
        • Aboyans V.
        • Criqui M.H.
        • Abraham P.
        • Allison M.A.
        • Creager M.A.
        • et al.
        Measurement and interpretation of the ankle-brachial index: a scientific statement from the American Heart Association.
        Circulation. 2012; 126: 2890-2909
        • Leng G.C.
        • Fowkes F.G.
        • Lee A.J.
        • Dunbar J.
        • Housley E.
        • et al.
        Use of ankle brachial pressure index to predict cardiovascular events and death: a cohort study.
        BMJ. 1996; 313: 1440-1444
        • Jönsson B.
        • Skau T.
        Ankle-brachial index and mortality in a cohort of questionnaire recorded leg pain on walking.
        Eur. J. Vasc. Endovasc. Surg. 2002; 24: 405-410
        • Criqui M.H.
        • Ninomiya J.K.
        • Wingard D.L.
        • Ji M.
        • Fronek A.
        Progression of peripheral arterial disease predicts cardiovascular disease morbidity and mortality.
        J. Am. Coll. Cardiol. 2008; 52: 1736-1742
        • Vogt M.T.
        • Cauley J.A.
        • Newman A.B.
        • Kuller L.H.
        • Hulley S.B.
        Decreased ankle/arm blood pressure index and mortality in elderly women.
        JAMA. 1993; 270: 465-469
        • Johnston L.E.
        • Stewart B.T.
        • Yangni-Angate H.
        • Veller M.
        • Upchurch G.R.
        • et al.
        Peripheral arterial disease in sub-Saharan Africa: a review.
        JAMA Surg. 2016; 151: 564-572
        • Desormais I.
        • Aboyans V.
        • Guerchet M.
        • Ndamba-Bandzouzi B.
        • Mbelesso P.
        • et al.
        Prevalence of peripheral artery disease in the elderly population in urban and rural areas of Central Africa: the EPIDEMCA study.
        Eur. J. Prev. Cardiol. 2014; 22: 1462-1472
        • Sampson U.K.A.
        • Fowkes F.G.R.
        • McDermott M.M.
        • Criqui M.H.
        • Aboyans V.
        • et al.
        Global and regional burden of death and disability from peripheral artery disease: 21 world regions, 1990 to 2010.
        Glob. Heart. 2014; 9: 145-158
        • Samba H.
        • Guerchet M.
        • Ndamba-Bandzouzi B.
        • Mbelesso P.
        • Lacroix P.
        • et al.
        Dementia-associated mortality and its predictors among older adults in sub-Saharan Africa: results from a 2-year follow-up in Congo (the EPIDEMCA-FU study).
        Age Ageing. 2016; 45: 681-687
        • Guerchet M.
        • Mbelesso P.
        • Ndamba-Bandzouzi B.
        • Pilleron S.
        • Desormais I.
        • et al.
        Epidemiology of dementia in Central Africa (EPIDEMCA): protocol for a multicentre population-based study in rural and urban areas of the Central African Republic and the Republic of Congo.
        SpringerPlus. 2014; 3: 338
        • WHO, World Health Organization
        Definition and Diagnosis of Diabetes Mellitus and Intermediate Hyperglycemia: Report of a WHO/IDF Consultation.
        2006
        • WHO, World Health Organisation Silent killer
        Global public health crisis. WHO/DCO/WHD/2013.2.
        in: A Global Brief on Hypertension. World Health Organization, Geneva2013
        • World Health Organization
        Physical Status: the Use and Interpretation of Anthropometry. Report of a WHO Expert Committee.
        World Health Organization, Geneva1984 (Technical Report Series No. 854)
        • Alberti K.G.
        • Eckel R.H.
        • Grundy S.M.
        • Zimmet P.Z.
        • Cleeman J.I.
        • et al.
        Harmonizing the metabolic syndrome: a joint interim statement of the international diabetes federation task force on Epidemiology and prevention; national Heart, lung, and blood Institute; American Heart association; world Heart federation; international atherosclerosis society; and international association for the study of obesity.
        Circulation. 2009; 120: 1640-1645
        • American Psychiatric Association
        DSM-IV-TR Manuel diagnostique et statistique des troubles mentaux: Texte révisé. 2003: 1064 (Paris: Masson)
        • Petersen R.C.
        Mild cognitive impairment as a diagnostic entity.
        J. Intern. Med. 2004; 256: 183-194
        • Newman A.
        • Siscovick D.S.
        • Manolio T.A.
        • Polak J.
        • Fried L.P.
        • et al.
        Ankle-arm index as a marker of atherosclerosis in the cardiovascular health study. Cardiovascular Heart study (CHS) collaborative research group.
        Circulation. 1993; 88: 837-845
        • Lee A.J.
        • Price J.F.
        • Russell M.J.
        • Smith F.B.
        • van Wijk M.C.W.
        • Fowkes F.G.R.
        Improved prediction of fatal myocardial infarction using the ankle brachial index in addition to conventional risk factors: the Edinburgh Artery Study.
        Circulation. 2004; 110: 3075-3080
        • Newman A.B.
        • Shemanski L.
        • Manolio T.A.
        • Cushman M.
        • Mittelmark M.
        • et al.
        Ankle-arm index as a predictor of cardiovascular disease and mortality in the cardiovascular health study. The cardiovascular health study group.
        Arterioscler. Thromb. Vasc. Biol. 1999; 19: 538-545
        • Hajibandeh S.
        • Hajibandeh S.
        • Shah S.
        • Child E.
        • Antonio G.A.
        • et al.
        Prognostic significance of ankle brachial pressure index: a systematic review and meta-analysis.
        Vascular. 2016; 25: 208-222
        • Ankle Brachial Index Collaboration
        • Fowkes F.G.
        • Murray G.D.
        • Butcher I.
        • Heald C.L.
        • et al.
        Ankle brachial index combined with Framingham Risk Score to predict cardiovascular events and mortality: a meta-analysis.
        JAMA. 2008; 300: 197-208
        • Aboyans V.
        • Lacroix P.
        • Laskar M.
        The level of knowledge of risk factors for peripheral arterial disease also depends on subjects' individual clinical situations.
        Can. J. Cardiol. 2009; 25: 545
        • The Wolrd Bank Data
        Life expectancy at birth, total (years). Derived from male and female life expectancy at birth from United Nations Population Division. World Population Prospects.
        (Available at:)
        • Allison M.A.
        • Ho E.
        • Denenberg J.O.
        • Langer R.D.
        • Newman A.B.
        • et al.
        Ethnic-specific prevalence of peripheral arterial disease in the United States.
        Am. J. Prev. Med. 2007; 32: 328-333
        • Zheng Z.J.
        • Rosamond W.D.
        • Chambless L.E.
        • Nieto F.J.
        • Barnes R.W.
        • et al.
        Lower extremity arterial disease assessed by ankle-brachial index in a middle-aged population of African Americans and whites: the Atherosclerosis Risk in Communities (ARIC) Study.
        Am. J. Prev. Med. 2005; 29: 42-49
        • Resnick H.E.
        • Lindsay R.S.
        • McDermott M.M.
        • Devereux R.B.
        • Jones K.L.
        • et al.
        Relationship of high and low ankle brachial index to all-cause and cardiovascular disease mortality: the Strong Heart Study.
        Circulation. 2004; 109: 733-739
        • O'Hare A.M.
        • Katz R.
        • Shlipak M.G.
        • Cushman M.
        • Newman A.B.
        Mortality and cardiovascular risk across the ankle-arm index spectrum: results from the Cardiovascular Health Study.
        Circulation. 2005; 113: 388-393
        • Resnick H.E.
        • Foster G.L.
        Prevalence of elevated ankle-brachial index in the United States 1999 to 2002.
        Am. J. Med. 2005; 118: 676-679
        • Guerchet M.
        • Aboyans V.
        • Mbelesso P.
        • Mouanga A.M.
        • Salazar J.
        • et al.
        Epidemiology of peripheral artery disease in elder general population of two cities of central Africa: Bangui and Brazzaville.
        Eur. J. Vasc. Endovasc. Surg. 2012; 44: 164-169