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Screening by Ankle–Brachial Index for Peripheral Artery or Cardiovascular Disease

Guideline Watch |
October 24, 2013

Screening by Ankle–Brachial Index for Peripheral Artery or Cardiovascular Disease

  1. Jamaluddin Moloo, MD, MPH

The U.S. Preventive Services Task Force concludes that evidence is insufficient to recommend for or against screening.

  1. Jamaluddin Moloo, MD, MPH

Sponsoring Organization: U.S. Preventive Services Task Force (USPSTF)

Target Population: U.S. physicians

Background and Objective

The ankle–brachial index (ABI) is calculated by dividing ankle systolic blood pressure by brachial systolic blood pressure when supine: A value of <0.9 is considered to be abnormal. Approximately 6% of U.S. adults older than 40 have abnormal ABIs. In this updated recommendation, the USPSTF assessed ABI as a screening test for peripheral artery disease (PAD) or as a risk predictor for cardiovascular disease in asymptomatic patients.

Key Points

  • Based on extrapolations from data on symptomatic adults, ABI is a reliable screening test for PAD. However, no evidence shows that screening for and treatment of PAD in asymptomatic patients results in clinically meaningful benefits.

  • Although using ABI in addition to Framingham risk score can reclassify some patients, evidence is inadequate to determine if early treatment of screen-detected PAD leads to better outcomes.

  • Evidence is insufficient to assess the balance of benefits and harms of PAD screening with ABI among asymptomatic adults without known cardiovascular disease or diabetes (I statement).

What's Changed

In 2006, the USPSTF recommended against screening for PAD (D recommendation; Am Fam Physician 2006; 73:497). The USPSTF now concludes that evidence is insufficient to make a recommendation.

Comment

The I statement from the USPSTF might be surprising to many people, given that the ankle–brachial index is a robust screening test for peripheral artery disease and can predict adverse cardiovascular events. However, PAD is unlikely to be present unless a patient has risk factors for cardiovascular disease. Given that such patients should be receiving care to modify risk anyway, that ABI testing would trigger additional interventions that would lower risk further is unlikely. And, among older U.S. men without cardiovascular disease or risk factors (smoking, hypertension, hypercholesterolemia, or diabetes), PAD is rare.

  • Disclosures for Jamaluddin Moloo, MD, MPH at time of publication Grant / research support NIH

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Reader Comments (1)

HAROON RASUL Physician, Cardiology, Hospital

i really appreciate the text available for academics

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