Associations of Borderline and Low Normal Ankle-Brachial Index Values With Functional Decline at 5-Year Follow-Up. The WALCS (Walking and Leg Circulation Study)

Mary M. McDermott*, Jack M. Guralnik, Lu Tian, Kiang Liu, Luigi Ferrucci, Yihua Liao, Leena Sharma, Michael H. Criqui

*Corresponding author for this work

Research output: Contribution to journalArticle

122 Scopus citations


Objectives: We studied associations of borderline and low normal ankle-brachial index (ABI) values with functional decline over a 5-year follow-up. Background: The associations of borderline and low normal ABI with functional decline are unknown. Methods: The 666 participants included 412 with peripheral arterial disease (PAD). Participants were categorized as follows: severe PAD (ABI <0.50), moderate PAD (ABI 0.50 to 0.69), mild PAD (ABI 0.70 to 0.89), borderline ABI (0.90 to 0.99), low normal ABI (1.00 to 1.09), and normal ABI (ABI 1.10 to 1.30). Outcomes were assessed annually for 5 years. Mobility loss was defined as loss of the ability to walk one-quarter mile or walk up and down 1 flight of stairs without assistance among participants without baseline mobility impairment. Becoming unable to walk for 6 min continuously was defined as stopping during the 6-min walk at follow-up among those who walked for 6 min continuously at baseline. Results were adjusted for age, sex, race, comorbidities, and other confounders. Results: Hazard ratios (HRs) for mobility loss according to ABI category were as follows: severe PAD, HR: 4.16 (95% confidence interval [CI]: 1.58 to 10.92); moderate PAD, HR: 3.82 (95% CI: 1.66 to 8.81); mild PAD, HR: 3.22 (95% CI: 1.43 to 7.21); borderline ABI, HR: 3.07 (95% CI: 1.21 to 7.84); and low normal ABI, HR: 2.61 (95% CI: 1.08 to 6.32; p trend = 0.0018). Similar associations were observed for becoming unable to walk for 6 min continuously (p trend < 0.0001). Conclusions: At 5-year follow-up, persons with borderline ABI values have a higher incidence of mobility loss and becoming unable to walk for 6 min continuously compared with persons who have a normal baseline ABI. A low normal ABI is associated with an increased incidence of mobility loss compared with persons who have a normal ABI.

Original languageEnglish (US)
Pages (from-to)1056-1062
Number of pages7
JournalJournal of the American College of Cardiology
Issue number12
StatePublished - Mar 24 2009



  • ankle-brachial index
  • intermittent claudication
  • peripheral arterial disease
  • physical functioning

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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