Ankle brachial index to predict cardiovascular events in primary health care, a systematic review

Article type
Authors
Galvão A1, Stein A2, Pellanda L3, Marcadenti A4
1Grupo Hospitalar Conceição
2Grupo Hospitalar Conceição / UFCSPA / ULBRA
3Instituto de Cardiologia - Fundação Universitária de Cardiologia / UFCSPA
4Grupo Hospitalar Conceiçáo / Cardiology postgraduation course UFRGS
Abstract
Background: Cardiovascular diseases still remain the most frequent cause of death in many countries, despite all measures and efforts that have been made to control risk factors and therapeutic approaches. Approximately half of all coronary deaths are not preceded by cardiac symptoms. In addition near 50% of all patients who have acute coronary syndrome are stratified, by risk score models, as just being an intermediate risk patient. The prevention of such events remains a serious public health challenge. Many previous studies have shown that the measurement of theankle brachial index (ABI) may improve the accuracy of cardiovascular risk prediction.

Objectives: The aim of this review is to provide an evidence-based approach to show how the measurement of the ABI, as an indicator of atherosclerosis, can improve risk assessment and predict cardiovascular events beyond the traditional used risk scores.

Methods: The ABI is the ratio of systolic pressure measured by doppler at the ankle to that in the arm. Risk prediction using the Framingham risk score (FRS) was also reviewed. A search of MEDLINE, Scielo, Cochrane Library, LILACS and EMBASE was conducted using common text words for the term ankle brachial index combined with primary health care and cardiovascular risk. A review of reference lists and conference proceedings wasperformed. We have identified relevant studies published about this topic and have been doing acritical appraisal of the articles selected. Studies for inclusion were independently assessed by 2 collaborators and disagreement was resolved by a third reviser.

Results: Preliminary results have shown that this question has not been completely replied in the literature and it is quite important for public health policies on this issue.

Conclusions: Measurement of the ABI in addition to other cardiovascular risk score models can stratify patients more accurately and also may improve the accuracy of cardiovascular risk prediction.