{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T21:03:59Z","timestamp":1775855039771,"version":"3.50.1"},"reference-count":38,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2022,3,10]],"date-time":"2022-03-10T00:00:00Z","timestamp":1646870400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003761","name":"Universitair Medisch Centrum Utrecht","doi-asserted-by":"publisher","award":["-"],"award-info":[{"award-number":["-"]}],"id":[{"id":"10.13039\/501100003761","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Objectives<\/jats:title>\n<jats:p>The ankle brachial index (ABI) can be used to diagnose peripheral arterial disease (PAD). The clinical relevance of the ABI, especially in patients with known clinically manifest cardiovascular disease (CVD), is unknown. The authors set out to investigate the relationship between a screen-detected ABI and the risk for future cardiovascular morbidity and mortality in patients with clinically manifest CVD.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Design, materials and methods<\/jats:title>\n<jats:p>Patients with clinically manifest CVD were selected from the UCC-SMART cohort (n = 8360) and divided into four groups: normal ABI (0.91\u20131.39), screen-detected low ABI \u2264 0.9, screen-detected high ABI \u2265 1.4, and patients with known PAD irrespective of their ABI. Adjusted Cox Proportional Hazard Ratios (HRs) for Major Adverse Cardiovascular Events (MACE), Major Adverse Limb Events (MALE), and all-cause mortality were calculated. In addition, stratified analyses for women and men and for the presence of diabetes were performed.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>During a median follow-up of 8.3 years (IQR 7.7) 1646 MACE, 601 MALE and 1958 all-cause mortalities were observed. Compared with normal ABI patients, patients with a screen-detected low ABI and patients with manifest PAD had a higher risk of MACE, MALE, and all-cause mortality with HRs of 1.9 (95% CI 1.6\u20132.2) for MACE, 7.6 (95% CI 5.7\u201310.1) for MALE, 1.7 (95% CI 1.5\u20132.0) for mortality and 1.3 (95% CI 1.2\u20131.5) for MACE, 13.8 (95% CI 11.1\u201317.1) for MALE, 1.7 (95% CI 1.5\u20131.9) for mortality, respectively. Screen-detected high ABI did not increase the risk of either MACE or MALE, however, was associated with lower risk of all-cause mortality with a HR of 0.6 (95% CI 0.5\u20130.9). Stratified analyses for women &amp; men and for diabetes status were comparable for all three outcomes.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>In patients with manifest CVD but without PAD, a screen-detected low ABI is a powerful risk indicator for cardiovascular events, limb events, and all-cause mortality.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0265050","type":"journal-article","created":{"date-parts":[[2022,3,10]],"date-time":"2022-03-10T18:54:49Z","timestamp":1646938489000},"page":"e0265050","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":6,"title":["Screen-detected abnormal ankle brachial index: A risk indicator for future cardiovascular morbidity and mortality in patients with manifest cardiovascular disease"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4283-6581","authenticated-orcid":true,"given":"Vivianne L.","family":"Jagt","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Constantijn E. V. B.","family":"Hazenberg","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jaap","family":"Kapelle","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maarten J.","family":"Cramer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frank L. J.","family":"Visseren","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jan","family":"Westerink","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"on behalf of the UCC-SMART Study Group","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2022,3,10]]},"reference":[{"key":"pone.0265050.ref001","doi-asserted-by":"crossref","first-page":"3472","DOI":"10.1161\/STROKEAHA.109.559278","article-title":"Association of asymptomatic peripheral arterial disease with vascular events in patients with stroke or transient ischemic attack","volume":"40","author":"S Sen","year":"2009","journal-title":"Stroke"},{"key":"pone.0265050.ref002","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1016\/j.ejvs.2009.09.002","article-title":"Asymptomatic low ankle-brachial index in vascular surgery patients: a predictor of perioperative myocardial damage","volume":"39","author":"W-J Flu","year":"2010","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"pone.0265050.ref003","doi-asserted-by":"crossref","first-page":"2599","DOI":"10.1111\/j.1538-7836.2006.02225.x","article-title":"Low ankle-brachial index predicts an adverse 1-year outcome after acute coronary and cerebrovascular events","volume":"4","author":"G Agnelli","year":"2006","journal-title":"J Thromb Haemost"},{"key":"pone.0265050.ref004","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1016\/j.amjcard.2012.03.013","article-title":"Prognostic usefulness of clinical and subclinical peripheral arterial disease in men with stable coronary heart disease","volume":"110","author":"F Bouisset","year":"2012","journal-title":"Am J Cardiol"},{"key":"pone.0265050.ref005","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1161\/STROKEAHA.115.011321","article-title":"Endres M, Siegerink B, Liman TG. 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