TY - JOUR
T1 - Ankle–brachial index and incident heart failure with reduced versus preserved ejection fraction
T2 - The Multi-Ethnic Study of Atherosclerosis
AU - Prasada, Sameer
AU - Shah, Sanjiv J.
AU - Michos, Erin D.
AU - Polak, Joseph F.
AU - Greenland, Philip
N1 - Funding Information:
The authors thank the other investigators, the staff, and the participants of the MESA study for their valuable contributions. A full list of participating MESA investigators and institutions can be found at http://www.mesa-nhlbi.org. The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Dr Shah is supported by National Institutes of Health grants R01 HL107577, R01 HL127028, and R01 HL140731. The views expressed in this manuscript are those of the authors and do not necessarily represent the views of the National Heart, Lung, and Blood Institute; the National Institutes of Health; or the US Department of Health and Human Services.
Funding Information:
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Dr Shah is supported by National Institutes of Health grants R01 HL107577, R01 HL127028, and R01 HL140731. The views expressed in this manuscript are those of the authors and do not necessarily represent the views of the National Heart, Lung, and Blood Institute; the National Institutes of Health; or the US Department of Health and Human Services.
Publisher Copyright:
© The Author(s) 2019.
PY - 2019/12/1
Y1 - 2019/12/1
N2 - 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.
AB - 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.
KW - ankle–brachial index (ABI)
KW - heart failure with preserved ejection fraction (HFpEF)
KW - heart failure with reduced ejection fraction (HFrEF)
KW - incident heart failure
KW - peripheral artery disease (PAD)
UR - http://www.scopus.com/inward/record.url?scp=85073795720&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85073795720&partnerID=8YFLogxK
U2 - 10.1177/1358863X19870602
DO - 10.1177/1358863X19870602
M3 - Article
C2 - 31480898
AN - SCOPUS:85073795720
SN - 1358-863X
VL - 24
SP - 501
EP - 510
JO - Vascular Medicine (United Kingdom)
JF - Vascular Medicine (United Kingdom)
IS - 6
ER -