Prevalence of high ankle–brachial index (ABI) in general population of Southern Italy, risk factor profiles and systemic cardiovascular co-morbidity: An epidemiological study Salvatore Santo Signorelli a, *, Valerio Fiore a , Stefano Catanzaro a , Massimo Simili a , Benedetto Torrisi b , Massimiliano Anzaldi a a Department of Internal Medicine and Systemic Diseases, Section for Internal and Vascular Medicine, University of Catania, Medical Angiology Unit, Garibaldi Hospital, Piazza S. Maria di Gesu ` 5, I-95123 Catania, Italy b Department of Economy, Section of Statistics, Faculty of Economy, University of Catania, Italy, Corso Italia, I-95124 Catania, Italy 1. Introduction The PAD affects a considerable number of people and has a negative impact on the quality of life and prognosis of these patients. Many studies, in fact, support the belief that PAD can interfere with normal daily life, principally with regard to physical activities, however also in common routines and social activities, due to physical and emotional impairment (McDermott et al., 2001; Liles et al., 2006). Furthermore, PAD is often associated with a poor prognosis in terms of co-morbidity, all causes of mortality and CV- specific mortality. PAD is clearly associated with other atheroscle- rotic localizations (mainly carotid, coronary and aortic atheroma- tosis) that frequently lead to clinically evident and dangerous complications, such as transient ischemic attack (TIA), stroke, acute myocardial infarction (AMI), angina and aortic aneurysms (with the consequent risk of rupture) (Criqui et al., 1991, 1992). Based on the aforesaid aspects, early identification of PAD and its preclinical and asymptomatic stages appear to be a useful step in order to prevent the progression of this disease and its consequences on leg health, while also offering an important diagnostic marker for appropriate wider CV screening aimed at preventing serious consequences through risk factor reduction and medical/surgical therapy. Many studies have focused on the prevalence of PAD in the general population by using a number of approaches (Criqui et al., 1985; Hirsch et al., 2001). Clinical questionnaires, such as the Rose’s questionnaire, surely represent the most simple, economic and rapid way to investigate the presence of arterial lower limb involvement, although they (particularly Rose’s) are affected by various bias due to their relatively low sensitivity and specificity and their poor applicability in some conditions, especially in cases Archives of Gerontology and Geriatrics 53 (2011) 55–59 A R T I C L E I N F O Article history: Received 5 February 2010 Received in revised form 25 May 2010 Accepted 27 May 2010 Available online 29 June 2010 Keywords: Ankle–brachial index (ABI) High-ABI Peripheral artery disease (PAD) Epidemiology Cardiovascular risk A B S T R A C T Many studies have been carried out to assess the prevalence, risk factors and co-morbidities of peripheral artery disease (PAD). By contrast, to date there is a lack of data on patients with high-ABI. This study aimed at estimating the prevalence of increased ABI (ABI > 1.4) and to evaluate the involvement of traditional cardiovascular (CV) risk factors and the atherosclerotic burden (peripheral and carotid arteries) of these patients in a population of Southern Italy. We invited 9647 subjects, age ranging from 30 to 80, by letters to undergo an ABI measurement. Consequently, in patients with ABI > 1.4, an ultrasound evaluation of the peripheral and carotid arteries was performed. An ABI > 1.4 was found in 260 of 3412 subjects (7.6%). Statistically significant differences were reported in age, diabetes and hypertension, body mass index (BMI) and waist circumference (WC). No differences in sex distribution, dyslipidemia and smoke prevalence were observed. Moreover, 67.9% of ABI > 1.4 patients showed a peripheral intima–media thickness (IMT) > 0.9 mm; at linear regression it was correlated with ABI values; 25% of patients showed peripheral plaques. A carotid IMT > 0.9 mm was reported in 78.6% of high-ABI patients and 32.1% were affected by atherosclerotic plaques. The observed increased-ABI prevalence of 7.6% was higher than previously reported. This was more prevalent in an older population with diabetes, hypertension and obesity. Moreover, these patients are characterized by an extended atherosclerotic involvement. Further studies are needed to clarify this evidence, a longitudinal observation of this clinical outcome, as we are performing, could provide a number of interesting elements. ß 2010 Published by Elsevier Ireland Ltd. * Corresponding author. Tel.: +39 095 715 9091; fax: +39 095 312 165. E-mail address: ssignore@unict.it (S.S. Signorelli). Contents lists available at ScienceDirect Archives of Gerontology and Geriatrics jo ur n al ho mep ag e: www .elsevier .c om /lo cate/ar c hg er 0167-4943/$ – see front matter ß 2010 Published by Elsevier Ireland Ltd. doi:10.1016/j.archger.2010.05.020