| Backgroud Ischemic stroke has become a major hazard factor for health, because of its high incidence, morbidity, mortality and recurrence rates, which affect people’s work efficiency and life quality seriously. Some studies reported that ankle-brachial index(ABI) can predict the risk of the composite of cardiovascular events independently, such as coronary heart disease, stroke and vascular mortality. However, the relationship between ABI and stroke is not consistent, and whether ABI can predict the risk of stroke remains controversial.Objective The present study was designed to study the relationship between ABI and asymptomatic cranial-carotid stenosis(ACCS) in baseline and to explore the predicting value of ABI for ischemic stroke(IS) after 3-year follow up among the asymptomatic residents from Kailuan community. Another view was to provide new ideas and reference for the early prevention of ischemic stroke, to reduce the harm caused by ischemic stroke and improve health and quality of life.Method The study was a prospective cohort study. A sample of 5,440 Chinese adults without cardiovascular disease history, aged 40 to 94 years old, was recruited from 2010 to 2011. Demographic variables, clinical examination, blood biochemistry and other information were included in baseline. The relationship bewtween ABI and IS was analyzed by using COX regression analysis. The association between ABI and ACCS was analyzed by using Logistic regression analysis.Result A total of 5224 subjects were included in our study after 216 individuals excluded because of the incomplete ABI information, with a average age of 55.2±11.8. Among total participants, 3134 were male(60.0%), female were 2090(40%). The prevalence of ACCS was 18.4%(943), with the prevalence of ICAS 13.4%(698) and prevalence of ECAS 6.7%(351). After a 3-year follow up, a total of 55 subjects suffered from IS, and the cumulative incidence of IS was 1.1%. After adjusted for age, sex, BMI, physical activity, smoking, alcohol consumption, hypertension, diabetes and hyperlipidemia, the higher value of ABI, the lower risk of suffering IS(HR=0.15, 95% CI: 0.03-0.70, p=0.015). After stratification by gender, the results remained positive in man(HR=0.14, 95% CI: 0.02-0.92, p=0.041) but negative in woman(HR=0.10, 95% CI: 0.01-2.67, p=0.168), and meanwhile remained positive in elderly group(HR=0.10, 95% CI: 0.02-0.57, p=0.010) but negative in the middle age group(HR=0.23, 95% CI: 0.02-5.66, p=0.368). After adjusted for confounders, the risk for IS in boundary value group was 3.68 times higher than that of the high value group(HR=3.63, 95% CI: 1.90-6.94, p<0.001). The risk for IS in low value group was not increased compared with high value group(HR=0.70, 95% CI: 0.17-2.98, p=0.633). The relationship remained positive in man(HR=3.91, 995% CI: 1.85-8.27, p<0.001) but negative in woman(HR=3.50, 95% CI: 0.95-12.97, p=0.061) after stratification by gender. In addition the relationship remains positive in elderly group(HR=7.23, 995% CI: 3.17-16.49, p<0.001) but negative in middle age group(HR=1.32, 95%CI : 0.40-4.41, p=0.979) after stratification by sex. High ABI was a protective factor for ACCS after adjusted for confounders(OR=0.18, 95% CI: 0.10-0.33, p<0.001). The association did not exist in the middle age population(OR=0.41, 95% CI: 0.15-1.08, p=0.072) after stratified for sex and age. Compared with the high value group, the boundary value group and low value group were risk factors for ACCS, and the risk was higher in low the value group(OR=2.05, 95% CI: 1.50-2.80, p<0.001) than boundary value group(OR=1.29, 95% CI: 1.01-1.66, p=0.046). After stratification by sex and age, the boundary value group was risk factor for ACCS in elderly(OR=2.08, 95% CI: 1.37-3.18, p<0.001) and the low value group was risk factor for ACCS in man(OR=2.40, 95% CI: 1.66-3.47, p < 0.001) and elderly(OR=3.44, 95% CI: 2.22-5.33, p < 0.001) respectively, compared with the high value group.Conclusion High ABI is a protective factor for IS. The risk of IS increased in boundary value group among man and elderly. The higher value of ABI is, the lower risk of suffering from ACCS. Compared with high the ABI group, the risk of ACCS increased in low value group among man and elderly and also increased in boundary value group among elderly. |
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