Development and validation of an ankle brachial index risk model for the prediction of cardiovascular events

Ankle Brachial Index Collaboration; F. G. R. Fowkes; G. D. Murray; I. Butcher; A. R. Folsom; A. T. Hirsch; D. J. Couper; G. DeBacker; M. Kornitzer; A. B. Newman; K. C. Sutton-Tyrrell; M. Cushman; A. J. Lee; J. F. Price; R. B. D'Agostino; J. M. Murabito; P. E. Norman; K. H. Masaki; L. M. Bouter; R. J. Heine; C. D. A. Stehouwer; M. M. McDermott; H. E. J. H. Stoffers; J. A. Knottnerus; M. Ogren; B. Hedblad; W. Koenig; C. Meisinger; J. A. Cauley; O. H. Franco; M. G. M. Hunink; A. Hofman; J. C. Witteman; M. H. Criqui; R. D. Langer; W. R. Hiatt; R. F. Hamman

doi:10.1177/2047487313516564

Development and validation of an ankle brachial index risk model for the prediction of cardiovascular events

Ankle Brachial Index Collaboration, F. G. R. Fowkes, G. D. Murray, I. Butcher, A. R. Folsom, A. T. Hirsch, D. J. Couper, G. DeBacker, M. Kornitzer, A. B. Newman, K. C. Sutton-Tyrrell, M. Cushman, A. J. Lee, J. F. Price, R. B. D'Agostino, J. M. Murabito, P. E. Norman, K. H. Masaki, L. M. Bouter, R. J. HeineC. D. A. Stehouwer, M. M. McDermott, H. E. J. H. Stoffers, J. A. Knottnerus, M. Ogren, B. Hedblad, W. Koenig, C. Meisinger, J. A. Cauley, O. H. Franco, M. G. M. Hunink, A. Hofman, J. C. Witteman, M. H. Criqui, R. D. Langer, W. R. Hiatt, R. F. Hamman

Research output: Contribution to journal › Article › peer-review

Abstract / Description of output

BACKGROUND: The ankle brachial index (ABI) is related to risk of cardiovascular events independent of the Framingham risk score (FRS). The aim of this study was to develop and evaluate a risk model for cardiovascular events incorporating the ABI and FRS.

DESIGN: An analysis of participant data from 18 cohorts in which 24,375 men and 20,377 women free of coronary heart disease had ABI measured and were followed up for events.

METHODS: Subjects were divided into a development and internal validation dataset and an external validation dataset. Two models, comprising FRS and FRS + ABI, were fitted for the primary outcome of major coronary events.

RESULTS: In predicting events in the external validation dataset, C-index for the FRS was 0.672 (95% CI 0.599 to 0.737) in men and 0.578 (95% CI 0.492 to 0.661) in women. The FRS + ABI led to a small increase in C-index in men to 0.685 (95% CI 0.612 to 0.749) and large increase in women to 0.690 (95% CI 0.605 to 0.764) with net reclassification improvement (NRI) of 4.3% (95% CI 0.0 to 7.6%, p = 0.050) and 9.6% (95% CI 6.1 to 16.4%, p < 0.001), respectively. Restricting the FRS + ABI model to those with FRS intermediate 10-year risk of 10 to 19% resulted in higher NRI of 15.9% (95% CI 6.1 to 20.6%, p < 0.001) in men and 23.3% (95% CI 13.8 to 62.5%, p = 0.002) in women. However, incorporating ABI in an improved newly fitted risk factor model had a nonsignificant effect: NRI 2.0% (95% CI 2.3 to 4.2%, p = 0.567) in men and 1.1% (95% CI 1.9 to 4.0%, p = 0.483) in women.

CONCLUSIONS: An ABI risk model may improve prediction especially in individuals at intermediate risk and when performance of the base risk factor model is modest.

Original language	English
Pages (from-to)	310-320
Number of pages	11
Journal	European Journal of Preventive Cardiology
Volume	21
Issue number	3
DOIs	https://doi.org/10.1177/2047487313516564
Publication status	Published - Mar 2014

Keywords / Materials (for Non-textual outputs)

Adult
Aged
Aged, 80 and over
Ankle Brachial Index
Cardiovascular Diseases
Europe
European Continental Ancestry Group
Female
Humans
Male
Middle Aged
Models, Statistical
Predictive Value of Tests
Prognosis
Reproducibility of Results
Risk Assessment
Risk Factors
Sex Factors
Time Factors
United States
Young Adult

Access to Document

10.1177/2047487313516564

MRC HUB NETWORK WORK
Murray, G.
MRC
1/01/09 → 31/08/15
Project: Research

Cite this

Ankle Brachial Index Collaboration, Fowkes, F. G. R., Murray, G. D., Butcher, I., Folsom, A. R., Hirsch, A. T., Couper, D. J., DeBacker, G., Kornitzer, M., Newman, A. B., Sutton-Tyrrell, K. C., Cushman, M., Lee, A. J., Price, J. F., D'Agostino, R. B., Murabito, J. M., Norman, P. E., Masaki, K. H., Bouter, L. M., ... Hamman, R. F. (2014). Development and validation of an ankle brachial index risk model for the prediction of cardiovascular events. European Journal of Preventive Cardiology, 21(3), 310-320. https://doi.org/10.1177/2047487313516564

@article{b561e43b961b41ffbcf06d652b819b1e,

title = "Development and validation of an ankle brachial index risk model for the prediction of cardiovascular events",

abstract = "BACKGROUND: The ankle brachial index (ABI) is related to risk of cardiovascular events independent of the Framingham risk score (FRS). The aim of this study was to develop and evaluate a risk model for cardiovascular events incorporating the ABI and FRS.DESIGN: An analysis of participant data from 18 cohorts in which 24,375 men and 20,377 women free of coronary heart disease had ABI measured and were followed up for events.METHODS: Subjects were divided into a development and internal validation dataset and an external validation dataset. Two models, comprising FRS and FRS + ABI, were fitted for the primary outcome of major coronary events.RESULTS: In predicting events in the external validation dataset, C-index for the FRS was 0.672 (95% CI 0.599 to 0.737) in men and 0.578 (95% CI 0.492 to 0.661) in women. The FRS + ABI led to a small increase in C-index in men to 0.685 (95% CI 0.612 to 0.749) and large increase in women to 0.690 (95% CI 0.605 to 0.764) with net reclassification improvement (NRI) of 4.3% (95% CI 0.0 to 7.6%, p = 0.050) and 9.6% (95% CI 6.1 to 16.4%, p < 0.001), respectively. Restricting the FRS + ABI model to those with FRS intermediate 10-year risk of 10 to 19% resulted in higher NRI of 15.9% (95% CI 6.1 to 20.6%, p < 0.001) in men and 23.3% (95% CI 13.8 to 62.5%, p = 0.002) in women. However, incorporating ABI in an improved newly fitted risk factor model had a nonsignificant effect: NRI 2.0% (95% CI 2.3 to 4.2%, p = 0.567) in men and 1.1% (95% CI 1.9 to 4.0%, p = 0.483) in women.CONCLUSIONS: An ABI risk model may improve prediction especially in individuals at intermediate risk and when performance of the base risk factor model is modest.",

keywords = "Adult, Aged, Aged, 80 and over, Ankle Brachial Index, Cardiovascular Diseases, Europe, European Continental Ancestry Group, Female, Humans, Male, Middle Aged, Models, Statistical, Predictive Value of Tests, Prognosis, Reproducibility of Results, Risk Assessment, Risk Factors, Sex Factors, Time Factors, United States, Young Adult",

author = "{Ankle Brachial Index Collaboration} and Fowkes, {F. G. R.} and Murray, {G. D.} and I. Butcher and Folsom, {A. R.} and Hirsch, {A. T.} and Couper, {D. J.} and G. DeBacker and M. Kornitzer and Newman, {A. B.} and Sutton-Tyrrell, {K. C.} and M. Cushman and Lee, {A. J.} and Price, {J. F.} and D'Agostino, {R. B.} and Murabito, {J. M.} and Norman, {P. E.} and Masaki, {K. H.} and Bouter, {L. M.} and Heine, {R. J.} and Stehouwer, {C. D. A.} and McDermott, {M. M.} and Stoffers, {H. E. J. H.} and Knottnerus, {J. A.} and M. Ogren and B. Hedblad and W. Koenig and C. Meisinger and Cauley, {J. A.} and Franco, {O. H.} and Hunink, {M. G. M.} and A. Hofman and Witteman, {J. C.} and Criqui, {M. H.} and Langer, {R. D.} and Hiatt, {W. R.} and Hamman, {R. F.}",

year = "2014",

month = mar,

doi = "10.1177/2047487313516564",

language = "English",

volume = "21",

pages = "310--320",

journal = "European Journal of Preventive Cardiology",

issn = "2047-4873",

publisher = "SAGE Publications",

number = "3",

}

Ankle Brachial Index Collaboration, Fowkes, FGR , Murray, GD, Butcher, I, Folsom, AR, Hirsch, AT, Couper, DJ, DeBacker, G, Kornitzer, M, Newman, AB, Sutton-Tyrrell, KC, Cushman, M, Lee, AJ, Price, JF, D'Agostino, RB, Murabito, JM, Norman, PE, Masaki, KH, Bouter, LM, Heine, RJ, Stehouwer, CDA, McDermott, MM, Stoffers, HEJH, Knottnerus, JA, Ogren, M, Hedblad, B, Koenig, W, Meisinger, C, Cauley, JA, Franco, OH, Hunink, MGM, Hofman, A, Witteman, JC, Criqui, MH, Langer, RD, Hiatt, WR & Hamman, RF 2014, 'Development and validation of an ankle brachial index risk model for the prediction of cardiovascular events', European Journal of Preventive Cardiology, vol. 21, no. 3, pp. 310-320. https://doi.org/10.1177/2047487313516564

TY - JOUR

T1 - Development and validation of an ankle brachial index risk model for the prediction of cardiovascular events

AU - Ankle Brachial Index Collaboration

AU - Fowkes, F. G. R.

AU - Murray, G. D.

AU - Butcher, I.

AU - Folsom, A. R.

AU - Hirsch, A. T.

AU - Couper, D. J.

AU - DeBacker, G.

AU - Kornitzer, M.

AU - Newman, A. B.

AU - Sutton-Tyrrell, K. C.

AU - Cushman, M.

AU - Lee, A. J.

AU - Price, J. F.

AU - D'Agostino, R. B.

AU - Murabito, J. M.

AU - Norman, P. E.

AU - Masaki, K. H.

AU - Bouter, L. M.

AU - Heine, R. J.

AU - Stehouwer, C. D. A.

AU - McDermott, M. M.

AU - Stoffers, H. E. J. H.

AU - Knottnerus, J. A.

AU - Ogren, M.

AU - Hedblad, B.

AU - Koenig, W.

AU - Meisinger, C.

AU - Cauley, J. A.

AU - Franco, O. H.

AU - Hunink, M. G. M.

AU - Hofman, A.

AU - Witteman, J. C.

AU - Criqui, M. H.

AU - Langer, R. D.

AU - Hiatt, W. R.

AU - Hamman, R. F.

PY - 2014/3

Y1 - 2014/3

N2 - BACKGROUND: The ankle brachial index (ABI) is related to risk of cardiovascular events independent of the Framingham risk score (FRS). The aim of this study was to develop and evaluate a risk model for cardiovascular events incorporating the ABI and FRS.DESIGN: An analysis of participant data from 18 cohorts in which 24,375 men and 20,377 women free of coronary heart disease had ABI measured and were followed up for events.METHODS: Subjects were divided into a development and internal validation dataset and an external validation dataset. Two models, comprising FRS and FRS + ABI, were fitted for the primary outcome of major coronary events.RESULTS: In predicting events in the external validation dataset, C-index for the FRS was 0.672 (95% CI 0.599 to 0.737) in men and 0.578 (95% CI 0.492 to 0.661) in women. The FRS + ABI led to a small increase in C-index in men to 0.685 (95% CI 0.612 to 0.749) and large increase in women to 0.690 (95% CI 0.605 to 0.764) with net reclassification improvement (NRI) of 4.3% (95% CI 0.0 to 7.6%, p = 0.050) and 9.6% (95% CI 6.1 to 16.4%, p < 0.001), respectively. Restricting the FRS + ABI model to those with FRS intermediate 10-year risk of 10 to 19% resulted in higher NRI of 15.9% (95% CI 6.1 to 20.6%, p < 0.001) in men and 23.3% (95% CI 13.8 to 62.5%, p = 0.002) in women. However, incorporating ABI in an improved newly fitted risk factor model had a nonsignificant effect: NRI 2.0% (95% CI 2.3 to 4.2%, p = 0.567) in men and 1.1% (95% CI 1.9 to 4.0%, p = 0.483) in women.CONCLUSIONS: An ABI risk model may improve prediction especially in individuals at intermediate risk and when performance of the base risk factor model is modest.

AB - BACKGROUND: The ankle brachial index (ABI) is related to risk of cardiovascular events independent of the Framingham risk score (FRS). The aim of this study was to develop and evaluate a risk model for cardiovascular events incorporating the ABI and FRS.DESIGN: An analysis of participant data from 18 cohorts in which 24,375 men and 20,377 women free of coronary heart disease had ABI measured and were followed up for events.METHODS: Subjects were divided into a development and internal validation dataset and an external validation dataset. Two models, comprising FRS and FRS + ABI, were fitted for the primary outcome of major coronary events.RESULTS: In predicting events in the external validation dataset, C-index for the FRS was 0.672 (95% CI 0.599 to 0.737) in men and 0.578 (95% CI 0.492 to 0.661) in women. The FRS + ABI led to a small increase in C-index in men to 0.685 (95% CI 0.612 to 0.749) and large increase in women to 0.690 (95% CI 0.605 to 0.764) with net reclassification improvement (NRI) of 4.3% (95% CI 0.0 to 7.6%, p = 0.050) and 9.6% (95% CI 6.1 to 16.4%, p < 0.001), respectively. Restricting the FRS + ABI model to those with FRS intermediate 10-year risk of 10 to 19% resulted in higher NRI of 15.9% (95% CI 6.1 to 20.6%, p < 0.001) in men and 23.3% (95% CI 13.8 to 62.5%, p = 0.002) in women. However, incorporating ABI in an improved newly fitted risk factor model had a nonsignificant effect: NRI 2.0% (95% CI 2.3 to 4.2%, p = 0.567) in men and 1.1% (95% CI 1.9 to 4.0%, p = 0.483) in women.CONCLUSIONS: An ABI risk model may improve prediction especially in individuals at intermediate risk and when performance of the base risk factor model is modest.

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Ankle Brachial Index

KW - Cardiovascular Diseases

KW - Europe

KW - European Continental Ancestry Group

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Models, Statistical

KW - Predictive Value of Tests

KW - Prognosis

KW - Reproducibility of Results

KW - Risk Assessment

KW - Risk Factors

KW - Sex Factors

KW - Time Factors

KW - United States

KW - Young Adult

U2 - 10.1177/2047487313516564

DO - 10.1177/2047487313516564

M3 - Article

C2 - 24367001

SN - 2047-4873

VL - 21

SP - 310

EP - 320

JO - European Journal of Preventive Cardiology

JF - European Journal of Preventive Cardiology

IS - 3

ER -

Development and validation of an ankle brachial index risk model for the prediction of cardiovascular events

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Keywords / Materials (for Non-textual outputs)

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