Relationships between ankle blood pressure indices and major adverse cardiovascular events in people with and without type 2 diabetes
Authors' conclusion
Inverse and independent associations were observed between ankle BP and cardiovascular events, similarly in people with and without type 2 diabetes. The largest associations were observed for heart failure and the smallest for stroke. Including ankle BP indices in routine clinical assessments may help to identify people at highest risk of cardiovascular outcomes.
Study context
- Population
- Trial participants with and without T2D (mean age 65.6 years, 31.3% female, 50.1% T2D, 53 countries); ankle systolic BP (SBP), ankle-brachial index (ABI) (ankle SBP / arm SBP) and ankle-pulse pressure difference (APPD) (ankle SBP minus arm pulse pressure) measured
- Participants
- 42,929 participants3 large trials
- Exposure
- Lower vs highest fourth of ankle blood pressure (BP) indices
- Outcome
- Composite of:
- CV mortality
- MI
- Hospitalization for HF
- Stroke
- Follow-up
- 5 years
Methodological detailspooled data from 3 large trials, multivariable-adjusted, 53 countries
- Pooled data from 3 large trials
- Multivariable-adjusted
- 53 countries
Main finding
As reported in the abstract
Primary composite outcome by fourth of ankle BP index · 5 years
Each group vs highest fourthEstimate (95% CI)
Second-highest fourth
aHR (ankle SBP) 1.05(0.98–1.12)
Second-lowest fourth
aHR (ankle SBP) 1.17(1.08–1.25)
Lowest fourth
aHR (ankle SBP) 1.54(1.54–1.65)
Second-highest fourth
aHR (ABI) 1.06(0.99–1.14)
Second-lowest fourth
aHR (ABI) 1.26(1.17–1.35)
Lowest fourth
aHR (ABI) 1.48(1.38–1.58)
Second-highest fourth
aHR (APPD) 1.02(0.95–1.10)
Second-lowest fourth
aHR (APPD) 1.15(1.07–1.23)
Lowest fourth
aHR (APPD) 1.48(1.38–1.58)
- Primary outcome occurred overall
- 7230 (16.8%)
Observational data: associations, not effects.
Secondary outcomes
Hospitalization for HF, by ankle BP index
- Ankle SBP, hazard ratios (HRs) for each lower fourth vs highest fourth
- 1.05 [0.90-1.21], 1.21 [1.05-1.40], and 1.93 [1.68-2.22]
- APPD, HRs for each lower fourth vs highest fourth
- 1.08 [0.93-1.26], 1.30 [1.12-1.50], and 1.97 [1.72-2.25]
- Largest effect size
Stroke
- Only a marginal association with ankle BP indices
Primary outcome by diabetes status · 5 years of follow-up
- Primary outcome in people with diabetes
- 19.4%
- Primary outcome in people without diabetes
- 14.3%
- Relationships similar in people with and without diabetes
- all p for interaction > 0.05
Original publication
Relationships between ankle blood pressure indices and major adverse cardiovascular events in people with and without type 2 diabetes. Cardiovasc Diabetol. Published 3 September 2024. doi:10.
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