מתוך medicontext.co.il
By Will Boggs, MD
WESTPORT, CT (Reuters Health) – As with cardiovascular death risk, stroke risk is increased in elderly men with a low ankle-brachial blood pressure index compared with men with higher indices, according to a report in the October Journal of Clinical Epidemiology.
Dr. Robert D. Abbott from University of Virginia School of Medicine in Charlottesville, Virginia and colleagues compared ankle-brachial blood pressure index (ABI) and stroke incidence in 2767 men aged 71 to 93 years who were followed in the Honolulu Heart Program. There were 91 strokes during followup.
The average mean ABI was 1.04, the authors report, and 11.6% of the men had an ABI below 0.9. Even after adjustments for age and other cardiovascular risk factors, men with an ABI less than 0.9 had twice the stroke risk as men with ABI of 0.9 and above, the report indicates.
Low ABI was also associated with a shorter median time to stroke (2 years) compared with that seen in men with ABI of 0.9 or higher (2.6 years), the researchers say. They add that ABI was inversely related to the incidence of both thromboembolic and hemorrhagic strokes.
"This may be the first report that has been able to describe an independent and inverse association between ABI and the risk of stroke," the authors conclude. "In contrast to a single risk factor, a low ABI in the elderly could represent a collection of lifetime exposures to a variety of risk factors in mid-life."
"Ankle-brachial blood pressure measurements should be part of the clinical evaluation of older patients," writes Dr. Lewis H. Kuller from the University of Pittsburgh in a related editorial. "The patient with a decreased ankle-brachial blood pressure might benefit from more aggressive reduction of the key risk factors."
"Improvements in levels of activity, diet, and smoking cessation should be the first course in disease prevention in these individuals," Dr. Abbott told Reuters Health. "Someone with a low ABI without any other risk factors might also warrant more frequent followup (as one might follow someone with hypertension or with hypercholesterolemia)."
"Unfortunately, while altering coexisting risk factors in the elderly person with a low ABI may warrant more aggressive intervention, clinical directions need to be better defined," Dr. Abbott concluded. "Hopefully this will happen as the ABI measurement becomes an accepted routine procedure in the elderly and becomes better understood as it is applied in day-to-day clinical practice."
תגובות רוצה להצטרף לדיון?
יש להתחבר כדי להגיב.
התחבראין תגובות עדיין. היה הראשון להגיב!