Aortic & peripheral vascular disease
Implications of Modest Reductions in Ankle-brachial Index (ABI) Measurements for Risk of Major Adverse Limb Events Among 223,350 Veterans
Authors' conclusion
In a large, diverse cohort free of prior PAD, ABI values across the full spectrum were associated with an increased risk of incident MALE, suggesting that treating the ABI as a binary measure does not adequately capture clinical risk.
Study context
- Population
- Veterans free of prevalent peripheral artery disease (PAD), enrolled from January 1, 2000, followed through September 30, 202128,191 major adverse limb events (MALE)
- Participants
- 223,350 veterans
- Exposure
- ABI categories vs ABI 1.11 to 1.20
- Outcome
- MALE:
- Amputation or revascularization
- Administrative codes
Methodological detailsVeterans Aging Cohort Study-National Cohort, adjusted for demographics and PAD risk factors
- Veterans Aging Cohort Study-National Cohort
- Adjusted for demographics and PAD risk factors
Main finding
As reported in the abstract
MALE
Borderline ABI vs ABI 1.11 to 1.20Hazard ratio (95% CI)
Total population
1.53(1.43–1.64)
Men
1.53(1.43–1.64)
Women
2.00(1.18–3.38)
White individuals
1.60(1.48–1.73)
Black individuals
1.39(1.18–1.64)
Observational data: associations, not effects.
Secondary outcomes
Major amputation, total amputation and revascularization (full cohort)
- Major amputation: similar association (HR, 95% CI)
- HR: 1.34 [95% CI: 1.17-1.54]
- Total amputation: similar association (HR, 95% CI)
- HR: 1.22 [95% CI: 1.12-1.33]
- Revascularization: similar association (HR, 95% CI)
- HR: 2.05 [95% CI: 1.87-2.26]
ABI vs established risk factors
- ABI a stronger marker of MALE risk than established risk factors, including current smoking and prevalent CVD
Original publication
Implications of Modest Reductions in ABI Measurements for Risk of Major Adverse Limb Events Among 223,350 Veterans. J Am Coll Cardiol. Published 27 May 2026. doi:10.
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