Janine Gronewold1, Dirk M Hermann2, Nils Lehmann3, Knut Kröger4, Karl Lauterbach5, Klaus Berger6, Christian Weimar7, Hagen I M Kälsch8, Susanne Moebus9, Karl-Heinz Jöckel10, Marcus Bauer11, Raimund Erbel12. 1. Department of Neurology, University Hospital, University of Duisburg-Essen, Hufelandstr. 55, D-45122 Essen, Germany. Electronic address: janine.gronewold@uk-essen.de. 2. Department of Neurology, University Hospital, University of Duisburg-Essen, Hufelandstr. 55, D-45122 Essen, Germany. Electronic address: dirk.hermann@uk-essen.de. 3. Institute of Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Germany. Electronic address: nils.lehmann@uk-essen.de. 4. Department of Angiology, Helios-Klinikum Krefeld, Germany. Electronic address: knut.kroeger@helios-kliniken.de. 5. Institute for Health Economics and Clinical Epidemiology, University of Cologne, Germany. Electronic address: karl.lauterbach@bundestag.de. 6. Institute of Epidemiology and Social Medicine, University of Münster, Germany. Electronic address: bergerk@uni-muenster.de. 7. Department of Neurology, University Hospital, University of Duisburg-Essen, Hufelandstr. 55, D-45122 Essen, Germany. Electronic address: christian.weimar@uk-essen.de. 8. Department of Cardiology, University Hospital, University Duisburg-Essen, Germany. Electronic address: hagen.kaelsch@uk-essen.de. 9. Institute of Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Germany. Electronic address: susanne.moebus@uk-essen.de. 10. Institute of Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Germany. Electronic address: k-h.joeckel@uk-essen.de. 11. Department of Cardiology, University Hospital, University Duisburg-Essen, Germany. Electronic address: marcus.bauer@uk-essen.de. 12. Department of Cardiology, University Hospital, University Duisburg-Essen, Germany. Electronic address: erbel@uk-essen.de.
Abstract
BACKGROUND: Predictors of future stroke events gain importance in vascular medicine. Herein, we investigated the value of the ankle-brachial index (ABI), a simple non-invasive marker of atherosclerosis, as stroke predictor in addition to established risk factors that are part of the Framingham risk score (FRS). METHODS: 4299 subjects from the population-based Heinz Nixdorf Recall study (45-75 years; 47.3% men) without previous stroke, coronary heart disease or myocardial infarcts were followed up for ischemic and hemorrhagic stroke events over 109.0±23.3 months. Cox proportional hazard regressions were used to evaluate ABI as stroke predictor in addition to established vascular risk factors (age, sex, systolic blood pressure, LDL, HDL, diabetes, smoking). RESULTS: 104 incident strokes (93 ischemic) occurred (incidence rate: 2.69/1000 person-years). Subjects suffering stroke had significantly lower ABI values at baseline than the remaining subjects (1.03±0.22 vs. 1.13±0.14, p<0.001). In a multivariable Cox regression, ABI predicted stroke in addition to classical risk factors (hazard ratio=0.77 per 0.1, 95% confidence interval=0.69-0.86). ABI predicted stroke events in subjects above and below 65 years, both in men and women. ABI specifically influenced stroke risk in subjects belonging to the highest (>13%) and intermediate (8-13%) FRS tercile. In these subjects, stroke incidence was 28.13 and 8.13/1000 person-years, respectively, for ABI<0.9, compared with 3.97 and 2.07/1000 person-years for 0.9≤ABI≤1.3. CONCLUSIONS: ABI predicts stroke in the general population, specifically in subjects with classical risk factors, where ABI identifies subjects at particularly high stroke risk.
BACKGROUND: Predictors of future stroke events gain importance in vascular medicine. Herein, we investigated the value of the ankle-brachial index (ABI), a simple non-invasive marker of atherosclerosis, as stroke predictor in addition to established risk factors that are part of the Framingham risk score (FRS). METHODS: 4299 subjects from the population-based Heinz Nixdorf Recall study (45-75 years; 47.3% men) without previous stroke, coronary heart disease or myocardial infarcts were followed up for ischemic and hemorrhagic stroke events over 109.0±23.3 months. Cox proportional hazard regressions were used to evaluate ABI as stroke predictor in addition to established vascular risk factors (age, sex, systolic blood pressure, LDL, HDL, diabetes, smoking). RESULTS: 104 incident strokes (93 ischemic) occurred (incidence rate: 2.69/1000 person-years). Subjects suffering stroke had significantly lower ABI values at baseline than the remaining subjects (1.03±0.22 vs. 1.13±0.14, p<0.001). In a multivariable Cox regression, ABI predicted stroke in addition to classical risk factors (hazard ratio=0.77 per 0.1, 95% confidence interval=0.69-0.86). ABI predicted stroke events in subjects above and below 65 years, both in men and women. ABI specifically influenced stroke risk in subjects belonging to the highest (>13%) and intermediate (8-13%) FRS tercile. In these subjects, stroke incidence was 28.13 and 8.13/1000 person-years, respectively, for ABI<0.9, compared with 3.97 and 2.07/1000 person-years for 0.9≤ABI≤1.3. CONCLUSIONS: ABI predicts stroke in the general population, specifically in subjects with classical risk factors, where ABI identifies subjects at particularly high stroke risk.
Authors: Emily R Cedarbaum; Yifei Ma; Adaora A Adimora; Marcas Bamman; Mardge H Cohen; Margaret A Fischl; Deborah Gustafson; Kunihiro Matsushita; Igho Ofotokun; Michael Plankey; Eric C Seaberg; Anjali Sharma; Phyllis C Tien Journal: AIDS Date: 2022-03-01 Impact factor: 4.177
Authors: Till Ittermann; Roberto Lorbeer; Daniel Tiller; Ina Lehmphul; Alexander Kluttig; Stephan B Felix; Karl Werdan; Karin Halina Greiser; Josef Köhrle; Henry Völzke; Marcus Dörr Journal: Eur Thyroid J Date: 2015-05-27
Authors: Oscar H Del Brutto; Mark J Sedler; Robertino M Mera; Pablo R Castillo; Elizabeth H Cusick; Jadry A Gruen; Kelsie J Phelan; Victor J Del Brutto; Mauricio Zambrano; David L Brown Journal: Int J Vasc Med Date: 2014-09-21
Authors: Line Melgaard; Anders Gorst-Rasmussen; Lars Hvilsted Rasmussen; Gregory Y H Lip; Torben Bjerregaard Larsen Journal: PLoS One Date: 2016-03-25 Impact factor: 3.240