Measurement characteristics of the ankle-brachial index: Results from the action for health in diabetes study

M. A. Espeland; J. G. Regensteiner; S. A. Jaramillo; E. W. Gregg; W. C. Knowler; L. E. Wagenknecht; J. Bahnson; S. Haffner; J. Hill; W. R. Hiatt; F. Brancati; D. Celnik; J. Honas; J. Clark; J. Charleston; L. Cheskin; K. Stewart; R. Rubin; K. Horak; G. A. Bray; K. Rau; A. Strate; F. L. Greenway; D. H. Ryan; D. Williamson; E. Tucker; B. Armand; M. Shipp; K. Landry; J. Perault; C. E. Lewis; S. Thomas; V. DiLillo; M. Safford; S. Glasser; C. Smith; C. Roche; C. Bragg; N. Webb; S. Gilbert; A. Dobelstein; L. C. Oden; T. Johnsey; D. M. Nathan; H. Turgeon; K. P. Schumann; E. Cagliero; K. Hayward; L. Delahanty; B. Steiner; V. Goldman; E. Anderson; L. Bissett; A. McNamara; R. Ginsburg; V. Harlan; T. Michel; E. S. Horton; S. D. Jackson; O. Hamdy; E. Caballero; S. Ledbury; M. Malloy; A. Goebel-Fabbri; K. Ovalle; S. Bain; E. Bovaird; L. Lambert; G. Blackburn; C. Mantzoros; H. McCormick; M. Miller; B. VanDorsten; J. Regenseiner; R. Schwartz; R. Hamman; M. McDermott; J. A. Phillipp; P. Reddin; K. Wallace; P. Cohrs; A. Hamilton; S. Benchekroun; S. Green; L. Rome; L. Munkwitz; J. P. Foreyt; R. S. Reeves; H. Pownall; P. Jones; A. Balasubramanyam; M. Gee; M. F. Saad; K. C. Chiu; S. Ghazarian; K. Szamos; M. Perpetua; M. Chan; M. Botrous; K. C. Johnson; L. Carmichael; L. Lichtermann; A. E. Kitabchi; J. Day; H. Lambeth; D. Force; D. Clark; A. Crisler; D. Green; G. Cunningham; M. Sun; R. Kores; R. Rosenthal; J. Soberman; R. W. Jeffery; C. Thorson; J. P. Bantle; B. Redmon; R. S. Crow; J. Carls; C. Campbell; L. D. James; T. Ockenden; K. Brelje; M. P. Snyder; A. Keranen; C. Walcheck; E. Finch; B. Rice; V. A. Maddy; T. Skarpol; X. Pi-Sunyer; J. Patricio; J. Mayer; S. Heshka; C. Pal; M. A. Holowaty; D. Hirsch; T. A. Wadden; B. J. Maschak-Carey; G. D. Foster; R. I. Berkowitz; S. Schwartz; S. K. Kumanyika; M. Mullen; L. Hesson; P. Lipschutz; A. Fabricatore; C. Crerand; R. Kuehnel; R. Carvajal; R. Davenport; H. Chomentowski; D. E. Kelley; J. Wesche-Thobaben; L. Kuller; A. Kriska; D. Edmundo-wicz; M. L. Klem; J. Bonk; J. Rush; R. Danchenko; B. Elnyczky; K. Vujevich; J. Krulia; D. Wolf; J. Mancino; P. Harper; A. Mathews; R. R. Wing; V. Pera; J. Jakicic; D. Tate; A. Gorin; R. Bright; P. Coward; N. Robinson; T. Monk; K. Gallagher; A. Bertorelli; M. Daly; T. Charron; R. Nicholson; E. Patterson; J. Currin; L. Foss; D. Robles; B. Bancroft; J. Gau-vin; D. Maier; C. Egan; S. Phelan; H. Raynor; D. Kieffer; D. Raynor; L. Lessard; K. Chula-Maquire; E. Ferguson; R. Carey; J. Tavares; H. Chenot; J. P. Massaro; M. Montez; C. Mobley; C. Lorenzo; S. E. Kahn; B. Montgomery; R. H. Knopp; E. W. Lipkin; M. L. Maciejewski; D. L. Trence; R. M. Murillo; T. Barrett; P. Bolin; T. Killean; C. Percy; R. Donaldson; B. Todacheenie; J. Glass; S. Michaels; J. Krakoff; J. Curtis; P. H. Bennett; T. Morgan; R. Johnson; C. Manus; J. Smiley; S. Sangster; S. Begay; M. Roanhorse; D. Fallis; N. Scurlock; L. Shovestull; D. Reboussin; J. Rejeski; W. Lang; A. Bertoni; M. Vitolins; G. Miller; P. Ribisl; K. Dotson; A. Hodges; P. Hogan; K. Lane; C. Combs; C. Speas; D. S. West; W. Herman; M. Nevitt; A. Schwartz; J. Shepherd; J. Maeda; C. Hayashi; M. Rahorst; L. Palermo; S. M. Marcovina; G. Strylewicz; R. J. Prineas; Z. M Zhang; S. Hall; E. J. Mayer-Davis; C. Farach; B. Harrison; S. Z. Yanovski; V. S. Hubbard; M. Evans; L. S. Cooper; E. Obarzanek; D. Simons-Morton; D. F. Williamson

doi:10.1177/1358863X08091338

Journal article

Measurement characteristics of the ankle-brachial index: Results from the action for health in diabetes study

M. A. Espeland, J. G. Regensteiner, S. A. Jaramillo, E. W. Gregg, W. C. Knowler, L. E. Wagenknecht, J. Bahnson, S. Haffner, J. Hill, W. R. Hiatt, …

Vascular Medicine, Vol.13(3)

2008

DOI: https://doi.org/10.1177/1358863X08091338

Abstract

Diagnostic error

Peripheral arterial disease

Sensitivity and specificity

adult

aged

ankle brachial index

article

cardiovascular risk

female

human

leg artery

major clinical study

male

mathematical model

measurement error

non insulin dependent diabetes mellitus

obesity

priority journal

risk assessment

systolic blood pressure

algorithm

ankle

blood pressure

brachial artery

cohort analysis

middle aged

pathophysiology

peripheral vascular disease

physiology

risk factor

vascularization

Algorithms

Ankle Joint

Cohort Studies

Diabetes Mellitus, Type 2

Humans

Peripheral Vascular Diseases

Risk Factors

Many protocols have been used in clinical and research settings for collecting systolic blood pressure (SBP) measurements to calculate the ankle-brachial index (ABI); however, it is not known how useful it is to replicate measurements and which measures best reflect cardiovascular risk. Standardized measurements of ankle and arm SBP from 5140 overweight or obese individuals with type 2 diabetes were used to estimate sources of variation. Measurement characteristics of leg-specific ABI, as calculated using a standard algorithm based on the highest SBP of the dorsalis pedis or posterior tibial arteries, were projected using simulations. Coefficients of variability ranged from 2% to 3% when single SBP measurements were used and ABI was overestimated by 2-3%. Taking two SBP measurements at each site reduced standard errors and bias each by 30-40%. The sensitivity of detecting low ABI ranges exceeded 90% for ABI within 0.05 of the 0.90 clinical cut-point. The average and the minimum of the two (i.e. right and left) leg-specific ABI values had similar U-shaped relationships with Framingham risk scores; however, the average leg ABI had slightly greater precision. Replicating SBP measurements reduces the error and bias of ABI. Averaging leg-specific values may increase power for characterizing cardiovascular disease risk.

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Title: Measurement characteristics of the ankle-brachial index: Results from the action for health in diabetes study
Creators: M. A. Espeland - Wake Forest University
J. G. Regensteiner - University of Colorado Health
S. A. Jaramillo - Wake Forest University
E. W. Gregg - Centers for Disease Control and Prevention
W. C. Knowler - National Institute of Diabetes and Digestive and Kidney Diseases
L. E. Wagenknecht - Wake Forest University
J. Bahnson - Wake Forest University
S. Haffner - The University of Texas Health Science Center at San Antonio
J. Hill - University of Colorado Health
W. R. Hiatt
F. Brancati
D. Celnik
J. Honas
J. Clark
J. Charleston
L. Cheskin
K. Stewart
R. Rubin
K. Horak
G. A. Bray
K. Rau
A. Strate
F. L. Greenway
D. H. Ryan
D. Williamson
E. Tucker
B. Armand
M. Shipp
K. Landry
J. Perault
C. E. Lewis
S. Thomas
V. DiLillo
M. Safford
S. Glasser
C. Smith
C. Roche
C. Bragg
N. Webb
S. Gilbert
A. Dobelstein
L. C. Oden
T. Johnsey
D. M. Nathan
H. Turgeon
K. P. Schumann
E. Cagliero
K. Hayward
L. Delahanty
B. Steiner
V. Goldman
E. Anderson
L. Bissett
A. McNamara
R. Ginsburg
V. Harlan
T. Michel
E. S. Horton
S. D. Jackson
O. Hamdy
E. Caballero
S. Ledbury
M. Malloy
A. Goebel-Fabbri
K. Ovalle
S. Bain
E. Bovaird
L. Lambert
G. Blackburn
C. Mantzoros
A. McNamara
H. McCormick
M. Miller
B. VanDorsten
J. Regenseiner
R. Schwartz
R. Hamman
M. McDermott
J. A. Phillipp
P. Reddin
K. Wallace
P. Cohrs
A. Hamilton
S. Benchekroun
S. Green
L. Rome
L. Munkwitz
J. P. Foreyt
R. S. Reeves
H. Pownall
P. Jones
A. Balasubramanyam
M. Gee
M. F. Saad
K. C. Chiu
S. Ghazarian
K. Szamos
M. Perpetua
M. Chan
M. Botrous
K. C. Johnson
L. Carmichael
L. Lichtermann
A. E. Kitabchi
J. Day
H. Lambeth
D. Force
D. Clark
A. Crisler
D. Green
G. Cunningham
M. Sun
R. Kores
R. Rosenthal
J. Soberman
R. W. Jeffery
C. Thorson
J. P. Bantle
B. Redmon
R. S. Crow
J. Carls
C. Campbell
L. D. James
T. Ockenden
K. Brelje
M. P. Snyder
A. Keranen
C. Walcheck
E. Finch
B. Rice
V. A. Maddy
T. Skarpol
X. Pi-Sunyer
J. Patricio
J. Mayer
S. Heshka
C. Pal
M. A. Holowaty
D. Hirsch
T. A. Wadden
B. J. Maschak-Carey
G. D. Foster
R. I. Berkowitz
S. Schwartz
S. K. Kumanyika
M. Mullen
L. Hesson
P. Lipschutz
A. Fabricatore
C. Crerand
R. Kuehnel
R. Carvajal
R. Davenport
H. Chomentowski
D. E. Kelley
J. Wesche-Thobaben
L. Kuller
A. Kriska
D. Edmundo-wicz
M. L. Klem
J. Bonk
J. Rush
R. Danchenko
B. Elnyczky
K. Vujevich
J. Krulia
D. Wolf
J. Mancino
P. Harper
A. Mathews
R. R. Wing
V. Pera
J. Jakicic
D. Tate
A. Gorin
R. Bright
P. Coward
N. Robinson
T. Monk
K. Gallagher
A. Bertorelli
M. Daly
T. Charron
R. Nicholson
E. Patterson
J. Currin
L. Foss
D. Robles
B. Bancroft
J. Gau-vin
D. Maier
C. Egan
S. Phelan
H. Raynor
D. Kieffer
D. Raynor
L. Lessard
K. Chula-Maquire
E. Ferguson
R. Carey
J. Tavares
H. Chenot
J. P. Massaro
M. Montez
C. Mobley
C. Lorenzo
S. E. Kahn
B. Montgomery
R. H. Knopp
E. W. Lipkin
M. L. Maciejewski
D. L. Trence
R. M. Murillo
T. Barrett
P. Bolin
T. Killean
C. Percy
R. Donaldson
B. Todacheenie
J. Glass
S. Michaels
J. Krakoff
J. Curtis
P. H. Bennett
T. Morgan
R. Johnson
C. Manus
J. Smiley
S. Sangster
S. Begay
M. Roanhorse
D. Fallis
N. Scurlock
L. Shovestull
D. Reboussin
J. Rejeski
W. Lang
A. Bertoni
M. Vitolins
G. Miller
P. Ribisl
K. Dotson
A. Hodges
P. Hogan
K. Lane
C. Combs
C. Speas
D. S. West
W. Herman
M. Nevitt
A. Schwartz
J. Shepherd
J. Maeda
C. Hayashi
M. Rahorst
L. Palermo
S. M. Marcovina
G. Strylewicz
R. J. Prineas
Z. M Zhang
C. Campbell
S. Hall
E. J. Mayer-Davis
C. Farach
B. Harrison
S. Z. Yanovski
V. S. Hubbard
M. Evans
L. S. Cooper
E. Obarzanek
D. Simons-Morton
D. F. Williamson
Publication Details: Vascular Medicine, Vol.13(3)
Identifiers: 1358863X; 991006028582202656
Academic Unit: Family and Community Medicine
Language: English
Resource Type: Journal article

Measurement characteristics of the ankle-brachial index: Results from the action for health in diabetes study

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