Association of incident cardiovascular events with unilateral low ankle-brachial index and bilateral low ankle-brachial index

The ankle-brachial index (ABI) represents a dependable approach to the early detection of lower extremity peripheral arterial disease, rendering it a valuable vascular marker for cardiovascular (CV) disease assessment [ 1 Aboyans V. Ricco J.B. Bartelink M.E.L. et al. 2017 ESC guidelines on the diagnosis and treatment of peripheral arterial diseases, in collaboration with the European Society for Vascular Surgery (ESVS): document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteriesEndorsed by: the European Stroke Organization (ESO) the task force for the diagnosis and treatment of peripheral arterial diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS). Eur Heart J. 2018; 39: 763-816https://doi.org/10.1093/eurheartj/ehx095 Crossref PubMed Scopus (2146) Google Scholar , 2 Williams B. Mancia G. Spiering W. et al. 2018 ESC/ESH guidelines for the management of arterial hypertension. Eur Heart J. 2018; 39: 3021-3104https://doi.org/10.1093/eurheartj/ehy339 Crossref PubMed Scopus (6481) Google Scholar , 3 Gerhard-Herman M.D. Gornik H.L. Barrett C. et al. 2016 AHA/ACC guideline on the management of patients with lower extremity peripheral artery disease: executive summary: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. Circulation. 2017; 135: e686-e725https://doi.org/10.1161/cir.0000000000000470 Crossref PubMed Scopus (0) Google Scholar ]. In the context of using ABI as an atherosclerosis indicator to evaluate CV risk, the selection of the lower ABI from either the left or right side is recommended [ 1 Aboyans V. Ricco J.B. Bartelink M.E.L. et al. 2017 ESC guidelines on the diagnosis and treatment of peripheral arterial diseases, in collaboration with the European Society for Vascular Surgery (ESVS): document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteriesEndorsed by: the European Stroke Organization (ESO) the task force for the diagnosis and treatment of peripheral arterial diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS). Eur Heart J. 2018; 39: 763-816https://doi.org/10.1093/eurheartj/ehx095 Crossref PubMed Scopus (2146) Google Scholar , 2 Williams B. Mancia G. Spiering W. et al. 2018 ESC/ESH guidelines for the management of arterial hypertension. Eur Heart J. 2018; 39: 3021-3104https://doi.org/10.1093/eurheartj/ehy339 Crossref PubMed Scopus (6481) Google Scholar , 3 Gerhard-Herman M.D. Gornik H.L. Barrett C. et al. 2016 AHA/ACC guideline on the management of patients with lower extremity peripheral artery disease: executive summary: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. Circulation. 2017; 135: e686-e725https://doi.org/10.1161/cir.0000000000000470 Crossref PubMed Scopus (0) Google Scholar ]. Both bilateral and unilateral low ABI are currently categorized under the same label, namely low ABI. However, it is plausible that individuals with bilateral low ABI face a greater risk of CV disease than those with unilateral low ABI. Substantiating this notion, a recent study indicated that individuals with bilateral low ABI exhibit a higher prevalence of CV disease than those with unilateral low ABI [ [4] Maruhashi T. Kajikawa M. Kishimoto S. et al. The prevalence of cardiovascular disease is higher in patients with bilateral low ankle-brachial index than in patients with unilateral low ankle-brachial index. Atherosclerosis. 2022; 360: 8-14https://doi.org/10.1016/j.atherosclerosis.2022.09.012 Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar ]. Nevertheless, uncertainties persist regarding the extent to which individuals with bilateral low ABI may experience organ damage (OD) and encounter major adverse cardiovascular events (MACEs) in the future, relative to their counterparts with unilateral low ABI. Therefore, we investigated the association of OD and the incidence of MACEs with unilateral and bilateral low ABI in a large cohort of Chinese elderly.