Measurement characteristics of the ankle-brachial index: Results from the action for health in diabetes study

Mark A. Espeland; Judith G. Regensteiner; Sarah A. Jaramillo; Edward Gregg; William C. Knowler; Lynne E. Wagenknecht; Judy Bahnson; Steven Haffner; James Hill; William R. Hiatt; Frederick Brancati; Debi Celnik; Jeff Honas; Jeanne Clark; Jeanne Charleston; Lawrence Cheskin; Kerry Stewart; Richard Rubin; Kathy Horak; George A. Bray; Kristi Rau; Allison Strate; Frank L. Greenway; Donna H. Ryan; Donald Williamson; Elizabeth Tucker; Brandi Armand; Mandy Shipp; Kim Landry; Jennifer Perault; Cora E. Lewis; Sheikilya Thomas; Vicki DiLillo; Monika Safford; Stephen Glasser; Clara Smith; Cathy Roche; Charlotte Bragg; Nita Webb; Straci Gilbert; Amy Dobelstein; L. Christie Oden; Trena Johnsey; David M. Nathan; Heather Turgeon; Kristina P. Schumann; Enrico Cagliero; Kathryn Hayward; Linda Delahanty; Barbara Steiner; Valerie Goldman; Ellen Anderson; Laurie Bissett; Alan McNamara; Richard Ginsburg; Virginia Harlan; Theresa Michel; Edward S. Horton; Sharon D. Jackson; Osama Hamdy; Enrique Caballero; Sarah Ledbury; Maureen Malloy; Ann Goebel-Fabbri; Kerry Ovalle; Sarah Bain; Elizabeth Bovaird; Lori Lambert; George Blackburn; Christos Mantzoros; Ann McNamara; Heather McCormick; James O. Hill; Marsha Miller; Brent VanDorsten; Judith Regenseiner; Robert Schwartz; Richard Hamman; Michael McDermott; Jo Ann Phillipp; Patrick Reddin; Kristin Wallace; Paulette Cohrs; April Hamilton; Salma Benchekroun; Susan Green; Loretta Rome; Lindsey Munkwitz; John P. Foreyt; Rebecca S. Reeves; Henry Pownall; Peter Jones; Ashok Balasubramanyam; Molly Gee; Mohammed F. Saad; Ken C. Chiu; Siran Ghazarian; Kati Szamos; Magpuri Perpetua; Michelle Chan; Medhat Botrous; Karen C. Johnson; Leeann Carmichael; Lynne Lichtermann; Abbas E. Kitabchi; Jackie Day; Helen Lambeth; Debra Force; Debra Clark; Andrea Crisler; Donna Green; Gracie Cunningham; Maria Sun; Robert Kores; Renate Rosenthal; Judith Soberman; Robert W. Jeffery; Carolyn Thorson; John P. Bantle; Bruce Redmon; Richard S. Crow; Jeanne Carls; Carolyne Campbell; La Donna James; T. Ockenden; Kerin Brelje; M. Patricia Snyder; Amy Keranen; Cara Walcheck; Emily Finch; Birgitta Rice; Vicki A. Maddy; Tricia Skarpol; Xavier Pi-Sunyer; Jennifer Patricio; Jennifer Mayer; Stanley Heshka; Carmen Pal; Mary Anne Holowaty; Diane Hirsch; Thomas A. Wadden; Barbara J. Maschak-Carey; Gary D. Foster; Robert I. Berkowitz; Stanley Schwartz; Shiriki K. Kumanyika; Monica Mullen; Louise Hesson; Patricia Lipschutz; Anthony Fabricatore; Canice Crerand; Robert Kuehnel; Ray Carvajal; Renee Davenport; Helen Chomentowski; David E. Kelley; Jacqueline Wesche-Thobaben; Lewis Kuller; Andrea Kriska; Daniel Edmundo-wicz; Mary L. Klem; Janet Bonk; Jennifer Rush; Rebecca Danchenko; Barb Elnyczky; Karen Vujevich; Janet Krulia; Donna Wolf; Juliet Mancino; Pat Harper; Anne Mathews; Rina R. Wing; Vincent Pera; John Jakicic; Deborah Tate; Amy Gorin; Renee Bright; Pamela Coward; Natalie Robinson; Tammy Monk; Kara Gallagher; Anna Bertorelli; Maureen Daly; Tatum Charron; Rob Nicholson; Erin Patterson; Julie Currin; Linda Foss; Deborah Robles; Barbara Bancroft; Jennifer Gau-vin; Deborah Maier; Caitlin Egan; Suzanne Phelan; Hollie Raynor; Don Kieffer; Douglas Raynor; Lauren Lessard; Kimberley Chula-Maquire; Erica Ferguson; Richard Carey; Jane Tavares; Heather Chenot; J. P. Massaro; Maria Montez; Connie Mobley; Carlos Lorenzo; Steven E. Kahn; Brenda Montgomery; Robert H. Knopp; Edward W. Lipkin; Matthew L. Maciejewski; Dace L. Trence; Roque M. Murillo; Terry Barrett; Paula Bolin; Tina Killean; Carol Percy; Rita Donaldson; Bernadette Todacheenie; Justin Glass; Sarah Michaels; Jonathan Krakoff; Jeffrey Curtis; Peter H. Bennett; Tina Morgan; Ruby Johnson; Cathy Manus; Janelia Smiley; Sandra Sangster; Shandiin Begay; Minnie Roanhorse; Didas Fallis; Nancy Scurlock; Leigh Shovestull; David Reboussin; Jack Rejeski; Wei Lang; Alain Bertoni; Mara Vitolins; Gary Miller; Paul Ribisl; Kathy Dotson; Amelia Hodges; Patricia Hogan; Kathy Lane; Carrie Combs; Christian Speas; Delia S. West; William Herman; Michael Nevitt; Ann Schwartz; John Shepherd; Jason Maeda; Cynthia Hayashi; Michaela Rahorst; Lisa Palermo; Santica M. Marcovina; Greg Strylewicz; Ronald J. Prineas; Zhu Ming Zhang; Charles Campbell; Sharon Hall; Elizabeth J. Mayer-Davis; Cecilia Farach; Barbara Harrison; Susan Z. Yanovski; Van S. Hubbard; Mary Evans; Lawton S. Cooper; Eva Obarzanek; Denise Simons-Morton; David F. Williamson; Edward W. Gregg

doi:10.1177/1358863X08091338

Measurement characteristics of the ankle-brachial index: Results from the action for health in diabetes study

Mark A. Espeland^*, Judith G. Regensteiner, Sarah A. Jaramillo, Edward Gregg, William C. Knowler, Lynne E. Wagenknecht, Judy Bahnson, Steven Haffner, James Hill, William R. Hiatt, Frederick Brancati, Debi Celnik, Jeff Honas, Jeanne Clark, Jeanne Charleston, Lawrence Cheskin, Kerry Stewart, Richard Rubin, Kathy Horak, George A. BrayKristi Rau, Allison Strate, Frank L. Greenway, Donna H. Ryan, Donald Williamson, Elizabeth Tucker, Brandi Armand, Mandy Shipp, Kim Landry, Jennifer Perault, Cora E. Lewis, Sheikilya Thomas, Vicki DiLillo, Monika Safford, Stephen Glasser, Clara Smith, Cathy Roche, Charlotte Bragg, Nita Webb, Straci Gilbert, Amy Dobelstein, L. Christie Oden, Trena Johnsey, David M. Nathan, Heather Turgeon, Kristina P. Schumann, Enrico Cagliero, Kathryn Hayward, Linda Delahanty, Barbara Steiner, Valerie Goldman, Ellen Anderson, Laurie Bissett, Alan McNamara, Richard Ginsburg, Virginia Harlan, Theresa Michel, Edward S. Horton, Sharon D. Jackson, Osama Hamdy, Enrique Caballero, Sarah Ledbury, Maureen Malloy, Ann Goebel-Fabbri, Kerry Ovalle, Sarah Bain, Elizabeth Bovaird, Lori Lambert, George Blackburn, Christos Mantzoros, Ann McNamara, Heather McCormick, James O. Hill, Marsha Miller, Brent VanDorsten, Judith Regenseiner, Robert Schwartz, Richard Hamman, Michael McDermott, Jo Ann Phillipp, Patrick Reddin, Kristin Wallace, Paulette Cohrs, April Hamilton, Salma Benchekroun, Susan Green, Loretta Rome, Lindsey Munkwitz, John P. Foreyt, Rebecca S. Reeves, Henry Pownall, Peter Jones, Ashok Balasubramanyam, Molly Gee, Mohammed F. Saad, Ken C. Chiu, Siran Ghazarian, Kati Szamos, Magpuri Perpetua, Michelle Chan, Medhat Botrous, Karen C. Johnson, Leeann Carmichael, Lynne Lichtermann, Abbas E. Kitabchi, Jackie Day, Helen Lambeth, Debra Force, Debra Clark, Andrea Crisler, Donna Green, Gracie Cunningham, Maria Sun, Robert Kores, Renate Rosenthal, Judith Soberman, Robert W. Jeffery, Carolyn Thorson, John P. Bantle, Bruce Redmon, Richard S. Crow, Jeanne Carls, Carolyne Campbell, La Donna James, T. Ockenden, Kerin Brelje, M. Patricia Snyder, Amy Keranen, Cara Walcheck, Emily Finch, Birgitta Rice, Vicki A. Maddy, Tricia Skarpol, Xavier Pi-Sunyer, Jennifer Patricio, Jennifer Mayer, Stanley Heshka, Carmen Pal, Mary Anne Holowaty, Diane Hirsch, Thomas A. Wadden, Barbara J. Maschak-Carey, Gary D. Foster, Robert I. Berkowitz, Stanley Schwartz, Shiriki K. Kumanyika, Monica Mullen, Louise Hesson, Patricia Lipschutz, Anthony Fabricatore, Canice Crerand, Robert Kuehnel, Ray Carvajal, Renee Davenport, Helen Chomentowski, David E. Kelley, Jacqueline Wesche-Thobaben, Lewis Kuller, Andrea Kriska, Daniel Edmundo-wicz, Mary L. Klem, Janet Bonk, Jennifer Rush, Rebecca Danchenko, Barb Elnyczky, Karen Vujevich, Janet Krulia, Donna Wolf, Juliet Mancino, Pat Harper, Anne Mathews, Rina R. Wing, Vincent Pera, John Jakicic, Deborah Tate, Amy Gorin, Renee Bright, Pamela Coward, Natalie Robinson, Tammy Monk, Kara Gallagher, Anna Bertorelli, Maureen Daly, Tatum Charron, Rob Nicholson, Erin Patterson, Julie Currin, Linda Foss, Deborah Robles, Barbara Bancroft, Jennifer Gau-vin, Deborah Maier, Caitlin Egan, Suzanne Phelan, Hollie Raynor, Don Kieffer, Douglas Raynor, Lauren Lessard, Kimberley Chula-Maquire, Erica Ferguson, Richard Carey, Jane Tavares, Heather Chenot, J. P. Massaro, Maria Montez, Connie Mobley, Carlos Lorenzo, Steven E. Kahn, Brenda Montgomery, Robert H. Knopp, Edward W. Lipkin, Matthew L. Maciejewski, Dace L. Trence, Roque M. Murillo, Terry Barrett, Paula Bolin, Tina Killean, Carol Percy, Rita Donaldson, Bernadette Todacheenie, Justin Glass, Sarah Michaels, Jonathan Krakoff, Jeffrey Curtis, Peter H. Bennett, Tina Morgan, Ruby Johnson, Cathy Manus, Janelia Smiley, Sandra Sangster, Shandiin Begay, Minnie Roanhorse, Didas Fallis, Nancy Scurlock, Leigh Shovestull, David Reboussin, Jack Rejeski, Wei Lang, Alain Bertoni, Mara Vitolins, Gary Miller, Paul Ribisl, Kathy Dotson, Amelia Hodges, Patricia Hogan, Kathy Lane, Carrie Combs, Christian Speas, Delia S. West, William Herman, Michael Nevitt, Ann Schwartz, John Shepherd, Jason Maeda, Cynthia Hayashi, Michaela Rahorst, Lisa Palermo, Santica M. Marcovina, Greg Strylewicz, Ronald J. Prineas, Zhu Ming Zhang, Charles Campbell, Sharon Hall, Elizabeth J. Mayer-Davis, Cecilia Farach, Barbara Harrison, Susan Z. Yanovski, Van S. Hubbard, Mary Evans, Lawton S. Cooper, Eva Obarzanek, Denise Simons-Morton, David F. Williamson, Edward W. Gregg

^*Corresponding author for this work

Medicine, General Medicine Division

Research output: Contribution to journal › Article › peer-review

13 Scopus citations

Abstract

Many protocols have been used in clinical and research settings for collecting systolic blood pressure (SBP) measurements to calculate the ankle-brachial index (ABI); however, it is not known how useful it is to replicate measurements and which measures best reflect cardiovascular risk. Standardized measurements of ankle and arm SBP from 5140 overweight or obese individuals with type 2 diabetes were used to estimate sources of variation. Measurement characteristics of leg-specific ABI, as calculated using a standard algorithm based on the highest SBP of the dorsalis pedis or posterior tibial arteries, were projected using simulations. Coefficients of variability ranged from 2% to 3% when single SBP measurements were used and ABI was overestimated by 2-3%. Taking two SBP measurements at each site reduced standard errors and bias each by 30-40%. The sensitivity of detecting low ABI ranges exceeded 90% for ABI within 0.05 of the 0.90 clinical cut-point. The average and the minimum of the two (i.e. right and left) leg-specific ABI values had similar U-shaped relationships with Framingham risk scores; however, the average leg ABI had slightly greater precision. Replicating SBP measurements reduces the error and bias of ABI. Averaging leg-specific values may increase power for characterizing cardiovascular disease risk.

Original language	English (US)
Pages (from-to)	225-233
Number of pages	9
Journal	Vascular Medicine
Volume	13
Issue number	3
DOIs	https://doi.org/10.1177/1358863X08091338
State	Published - 2008

Keywords

Diagnostic error
Peripheral arterial disease
Sensitivity and specificity

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1177/1358863X08091338

Cite this

Espeland, M. A., Regensteiner, J. G., Jaramillo, S. A., Gregg, E., Knowler, W. C., Wagenknecht, L. E., Bahnson, J., Haffner, S., Hill, J., Hiatt, W. R., Brancati, F., Celnik, D., Honas, J., Clark, J., Charleston, J., Cheskin, L., Stewart, K., Rubin, R., Horak, K., ... Gregg, E. W. (2008). Measurement characteristics of the ankle-brachial index: Results from the action for health in diabetes study. Vascular Medicine, 13(3), 225-233. https://doi.org/10.1177/1358863X08091338

@article{ed473f5d47ce4bb588a349c8a905f685,

title = "Measurement characteristics of the ankle-brachial index: Results from the action for health in diabetes study",

abstract = "Many protocols have been used in clinical and research settings for collecting systolic blood pressure (SBP) measurements to calculate the ankle-brachial index (ABI); however, it is not known how useful it is to replicate measurements and which measures best reflect cardiovascular risk. Standardized measurements of ankle and arm SBP from 5140 overweight or obese individuals with type 2 diabetes were used to estimate sources of variation. Measurement characteristics of leg-specific ABI, as calculated using a standard algorithm based on the highest SBP of the dorsalis pedis or posterior tibial arteries, were projected using simulations. Coefficients of variability ranged from 2% to 3% when single SBP measurements were used and ABI was overestimated by 2-3%. Taking two SBP measurements at each site reduced standard errors and bias each by 30-40%. The sensitivity of detecting low ABI ranges exceeded 90% for ABI within 0.05 of the 0.90 clinical cut-point. The average and the minimum of the two (i.e. right and left) leg-specific ABI values had similar U-shaped relationships with Framingham risk scores; however, the average leg ABI had slightly greater precision. Replicating SBP measurements reduces the error and bias of ABI. Averaging leg-specific values may increase power for characterizing cardiovascular disease risk.",

keywords = "Diagnostic error, Peripheral arterial disease, Sensitivity and specificity",

author = "Espeland, {Mark A.} and Regensteiner, {Judith G.} and Jaramillo, {Sarah A.} and Edward Gregg and Knowler, {William C.} and Wagenknecht, {Lynne E.} and Judy Bahnson and Steven Haffner and James Hill and Hiatt, {William R.} and Frederick Brancati and Debi Celnik and Jeff Honas and Jeanne Clark and Jeanne Charleston and Lawrence Cheskin and Kerry Stewart and Richard Rubin and Kathy Horak and Bray, {George A.} and Kristi Rau and Allison Strate and Greenway, {Frank L.} and Ryan, {Donna H.} and Donald Williamson and Elizabeth Tucker and Brandi Armand and Mandy Shipp and Kim Landry and Jennifer Perault and Lewis, {Cora E.} and Sheikilya Thomas and Vicki DiLillo and Monika Safford and Stephen Glasser and Clara Smith and Cathy Roche and Charlotte Bragg and Nita Webb and Straci Gilbert and Amy Dobelstein and Oden, {L. Christie} and Trena Johnsey and Nathan, {David M.} and Heather Turgeon and Schumann, {Kristina P.} and Enrico Cagliero and Kathryn Hayward and Linda Delahanty and Barbara Steiner and Valerie Goldman and Ellen Anderson and Laurie Bissett and Alan McNamara and Richard Ginsburg and Virginia Harlan and Theresa Michel and Horton, {Edward S.} and Jackson, {Sharon D.} and Osama Hamdy and Enrique Caballero and Sarah Ledbury and Maureen Malloy and Ann Goebel-Fabbri and Kerry Ovalle and Sarah Bain and Elizabeth Bovaird and Lori Lambert and George Blackburn and Christos Mantzoros and Ann McNamara and Heather McCormick and Hill, {James O.} and Marsha Miller and Brent VanDorsten and Judith Regenseiner and Robert Schwartz and Richard Hamman and Michael McDermott and Phillipp, {Jo Ann} and Patrick Reddin and Kristin Wallace and Paulette Cohrs and April Hamilton and Salma Benchekroun and Susan Green and Loretta Rome and Lindsey Munkwitz and Foreyt, {John P.} and Reeves, {Rebecca S.} and Henry Pownall and Peter Jones and Ashok Balasubramanyam and Molly Gee and Saad, {Mohammed F.} and Chiu, {Ken C.} and Siran Ghazarian and Kati Szamos and Magpuri Perpetua and Michelle Chan and Medhat Botrous and Johnson, {Karen C.} and Leeann Carmichael and Lynne Lichtermann and Kitabchi, {Abbas E.} and Jackie Day and Helen Lambeth and Debra Force and Debra Clark and Andrea Crisler and Donna Green and Gracie Cunningham and Maria Sun and Robert Kores and Renate Rosenthal and Judith Soberman and Jeffery, {Robert W.} and Carolyn Thorson and Bantle, {John P.} and Bruce Redmon and Crow, {Richard S.} and Jeanne Carls and Carolyne Campbell and James, {La Donna} and T. Ockenden and Kerin Brelje and Snyder, {M. Patricia} and Amy Keranen and Cara Walcheck and Emily Finch and Birgitta Rice and Maddy, {Vicki A.} and Tricia Skarpol and Xavier Pi-Sunyer and Jennifer Patricio and Jennifer Mayer and Stanley Heshka and Carmen Pal and Holowaty, {Mary Anne} and Diane Hirsch and Wadden, {Thomas A.} and Maschak-Carey, {Barbara J.} and Foster, {Gary D.} and Berkowitz, {Robert I.} and Stanley Schwartz and Kumanyika, {Shiriki K.} and Monica Mullen and Louise Hesson and Patricia Lipschutz and Anthony Fabricatore and Canice Crerand and Robert Kuehnel and Ray Carvajal and Renee Davenport and Helen Chomentowski and Kelley, {David E.} and Jacqueline Wesche-Thobaben and Lewis Kuller and Andrea Kriska and Daniel Edmundo-wicz and Klem, {Mary L.} and Janet Bonk and Jennifer Rush and Rebecca Danchenko and Barb Elnyczky and Karen Vujevich and Janet Krulia and Donna Wolf and Juliet Mancino and Pat Harper and Anne Mathews and Wing, {Rina R.} and Vincent Pera and John Jakicic and Deborah Tate and Amy Gorin and Renee Bright and Pamela Coward and Natalie Robinson and Tammy Monk and Kara Gallagher and Anna Bertorelli and Maureen Daly and Tatum Charron and Rob Nicholson and Erin Patterson and Julie Currin and Linda Foss and Deborah Robles and Barbara Bancroft and Jennifer Gau-vin and Deborah Maier and Caitlin Egan and Suzanne Phelan and Hollie Raynor and Don Kieffer and Douglas Raynor and Lauren Lessard and Kimberley Chula-Maquire and Erica Ferguson and Richard Carey and Jane Tavares and Heather Chenot and Massaro, {J. P.} and Maria Montez and Connie Mobley and Carlos Lorenzo and Kahn, {Steven E.} and Brenda Montgomery and Knopp, {Robert H.} and Lipkin, {Edward W.} and Maciejewski, {Matthew L.} and Trence, {Dace L.} and Murillo, {Roque M.} and Terry Barrett and Paula Bolin and Tina Killean and Carol Percy and Rita Donaldson and Bernadette Todacheenie and Justin Glass and Sarah Michaels and Jonathan Krakoff and Jeffrey Curtis and Bennett, {Peter H.} and Tina Morgan and Ruby Johnson and Cathy Manus and Janelia Smiley and Sandra Sangster and Shandiin Begay and Minnie Roanhorse and Didas Fallis and Nancy Scurlock and Leigh Shovestull and David Reboussin and Jack Rejeski and Wei Lang and Alain Bertoni and Mara Vitolins and Gary Miller and Paul Ribisl and Kathy Dotson and Amelia Hodges and Patricia Hogan and Kathy Lane and Carrie Combs and Christian Speas and West, {Delia S.} and William Herman and Michael Nevitt and Ann Schwartz and John Shepherd and Jason Maeda and Cynthia Hayashi and Michaela Rahorst and Lisa Palermo and Marcovina, {Santica M.} and Greg Strylewicz and Prineas, {Ronald J.} and Zhang, {Zhu Ming} and Charles Campbell and Sharon Hall and Mayer-Davis, {Elizabeth J.} and Cecilia Farach and Barbara Harrison and Yanovski, {Susan Z.} and Hubbard, {Van S.} and Mary Evans and Cooper, {Lawton S.} and Eva Obarzanek and Denise Simons-Morton and Williamson, {David F.} and Gregg, {Edward W.}",

year = "2008",

doi = "10.1177/1358863X08091338",

language = "English (US)",

volume = "13",

pages = "225--233",

journal = "Vascular Medicine",

issn = "1358-863X",

publisher = "SAGE Publications Ltd",

number = "3",

}

Espeland, MA, Regensteiner, JG, Jaramillo, SA, Gregg, E, Knowler, WC, Wagenknecht, LE, Bahnson, J, Haffner, S, Hill, J, Hiatt, WR, Brancati, F, Celnik, D, Honas, J, Clark, J, Charleston, J, Cheskin, L, Stewart, K, Rubin, R, Horak, K, Bray, GA, Rau, K, Strate, A, Greenway, FL, Ryan, DH, Williamson, D, Tucker, E, Armand, B, Shipp, M, Landry, K, Perault, J, Lewis, CE, Thomas, S, DiLillo, V, Safford, M, Glasser, S, Smith, C, Roche, C, Bragg, C, Webb, N, Gilbert, S, Dobelstein, A, Oden, LC, Johnsey, T, Nathan, DM, Turgeon, H, Schumann, KP, Cagliero, E, Hayward, K, Delahanty, L, Steiner, B, Goldman, V, Anderson, E, Bissett, L, McNamara, A, Ginsburg, R, Harlan, V, Michel, T, Horton, ES, Jackson, SD, Hamdy, O, Caballero, E, Ledbury, S, Malloy, M, Goebel-Fabbri, A, Ovalle, K, Bain, S, Bovaird, E, Lambert, L, Blackburn, G, Mantzoros, C, McNamara, A, McCormick, H, Hill, JO, Miller, M, VanDorsten, B, Regenseiner, J, Schwartz, R, Hamman, R, McDermott, M, Phillipp, JA, Reddin, P, Wallace, K, Cohrs, P, Hamilton, A, Benchekroun, S, Green, S, Rome, L, Munkwitz, L, Foreyt, JP, Reeves, RS, Pownall, H, Jones, P, Balasubramanyam, A, Gee, M, Saad, MF, Chiu, KC, Ghazarian, S, Szamos, K, Perpetua, M, Chan, M, Botrous, M, Johnson, KC, Carmichael, L, Lichtermann, L, Kitabchi, AE, Day, J, Lambeth, H, Force, D, Clark, D, Crisler, A, Green, D, Cunningham, G, Sun, M, Kores, R, Rosenthal, R, Soberman, J, Jeffery, RW, Thorson, C, Bantle, JP, Redmon, B, Crow, RS, Carls, J, Campbell, C, James, LD, Ockenden, T, Brelje, K, Snyder, MP, Keranen, A, Walcheck, C, Finch, E, Rice, B, Maddy, VA, Skarpol, T, Pi-Sunyer, X, Patricio, J, Mayer, J, Heshka, S, Pal, C, Holowaty, MA, Hirsch, D, Wadden, TA, Maschak-Carey, BJ, Foster, GD, Berkowitz, RI, Schwartz, S, Kumanyika, SK, Mullen, M, Hesson, L, Lipschutz, P, Fabricatore, A, Crerand, C, Kuehnel, R, Carvajal, R, Davenport, R, Chomentowski, H, Kelley, DE, Wesche-Thobaben, J, Kuller, L, Kriska, A, Edmundo-wicz, D, Klem, ML, Bonk, J, Rush, J, Danchenko, R, Elnyczky, B, Vujevich, K, Krulia, J, Wolf, D, Mancino, J, Harper, P, Mathews, A, Wing, RR, Pera, V, Jakicic, J, Tate, D, Gorin, A, Bright, R, Coward, P, Robinson, N, Monk, T, Gallagher, K, Bertorelli, A, Daly, M, Charron, T, Nicholson, R, Patterson, E, Currin, J, Foss, L, Robles, D, Bancroft, B, Gau-vin, J, Maier, D, Egan, C, Phelan, S, Raynor, H, Kieffer, D, Raynor, D, Lessard, L, Chula-Maquire, K, Ferguson, E, Carey, R, Tavares, J, Chenot, H, Massaro, JP, Montez, M, Mobley, C, Lorenzo, C, Kahn, SE, Montgomery, B, Knopp, RH, Lipkin, EW, Maciejewski, ML, Trence, DL, Murillo, RM, Barrett, T, Bolin, P, Killean, T, Percy, C, Donaldson, R, Todacheenie, B, Glass, J, Michaels, S, Krakoff, J, Curtis, J, Bennett, PH, Morgan, T, Johnson, R, Manus, C, Smiley, J, Sangster, S, Begay, S, Roanhorse, M, Fallis, D, Scurlock, N, Shovestull, L, Reboussin, D, Rejeski, J, Lang, W, Bertoni, A, Vitolins, M, Miller, G, Ribisl, P, Dotson, K, Hodges, A, Hogan, P, Lane, K, Combs, C, Speas, C, West, DS, Herman, W, Nevitt, M, Schwartz, A, Shepherd, J, Maeda, J, Hayashi, C, Rahorst, M, Palermo, L, Marcovina, SM, Strylewicz, G, Prineas, RJ, Zhang, ZM, Campbell, C, Hall, S, Mayer-Davis, EJ, Farach, C, Harrison, B, Yanovski, SZ, Hubbard, VS, Evans, M, Cooper, LS, Obarzanek, E, Simons-Morton, D, Williamson, DF & Gregg, EW 2008, 'Measurement characteristics of the ankle-brachial index: Results from the action for health in diabetes study', Vascular Medicine, vol. 13, no. 3, pp. 225-233. https://doi.org/10.1177/1358863X08091338

TY - JOUR

T1 - Measurement characteristics of the ankle-brachial index

T2 - Results from the action for health in diabetes study

AU - Espeland, Mark A.

AU - Regensteiner, Judith G.

AU - Jaramillo, Sarah A.

AU - Gregg, Edward

AU - Knowler, William C.

AU - Wagenknecht, Lynne E.

AU - Bahnson, Judy

AU - Haffner, Steven

AU - Hill, James

AU - Hiatt, William R.

AU - Brancati, Frederick

AU - Celnik, Debi

AU - Honas, Jeff

AU - Clark, Jeanne

AU - Charleston, Jeanne

AU - Cheskin, Lawrence

AU - Stewart, Kerry

AU - Rubin, Richard

AU - Horak, Kathy

AU - Bray, George A.

AU - Rau, Kristi

AU - Strate, Allison

AU - Greenway, Frank L.

AU - Ryan, Donna H.

AU - Williamson, Donald

AU - Tucker, Elizabeth

AU - Armand, Brandi

AU - Shipp, Mandy

AU - Landry, Kim

AU - Perault, Jennifer

AU - Lewis, Cora E.

AU - Thomas, Sheikilya

AU - DiLillo, Vicki

AU - Safford, Monika

AU - Glasser, Stephen

AU - Smith, Clara

AU - Roche, Cathy

AU - Bragg, Charlotte

AU - Webb, Nita

AU - Gilbert, Straci

AU - Dobelstein, Amy

AU - Oden, L. Christie

AU - Johnsey, Trena

AU - Nathan, David M.

AU - Turgeon, Heather

AU - Schumann, Kristina P.

AU - Cagliero, Enrico

AU - Hayward, Kathryn

AU - Delahanty, Linda

AU - Steiner, Barbara

AU - Goldman, Valerie

AU - Anderson, Ellen

AU - Bissett, Laurie

AU - McNamara, Alan

AU - Ginsburg, Richard

AU - Harlan, Virginia

AU - Michel, Theresa

AU - Horton, Edward S.

AU - Jackson, Sharon D.

AU - Hamdy, Osama

AU - Caballero, Enrique

AU - Ledbury, Sarah

AU - Malloy, Maureen

AU - Goebel-Fabbri, Ann

AU - Ovalle, Kerry

AU - Bain, Sarah

AU - Bovaird, Elizabeth

AU - Lambert, Lori

AU - Blackburn, George

AU - Mantzoros, Christos

AU - McNamara, Ann

AU - McCormick, Heather

AU - Hill, James O.

AU - Miller, Marsha

AU - VanDorsten, Brent

AU - Regenseiner, Judith

AU - Schwartz, Robert

AU - Hamman, Richard

AU - McDermott, Michael

AU - Phillipp, Jo Ann

AU - Reddin, Patrick

AU - Wallace, Kristin

AU - Cohrs, Paulette

AU - Hamilton, April

AU - Benchekroun, Salma

AU - Green, Susan

AU - Rome, Loretta

AU - Munkwitz, Lindsey

AU - Foreyt, John P.

AU - Reeves, Rebecca S.

AU - Pownall, Henry

AU - Jones, Peter

AU - Balasubramanyam, Ashok

AU - Gee, Molly

AU - Saad, Mohammed F.

AU - Chiu, Ken C.

AU - Ghazarian, Siran

AU - Szamos, Kati

AU - Perpetua, Magpuri

AU - Chan, Michelle

AU - Botrous, Medhat

AU - Johnson, Karen C.

AU - Carmichael, Leeann

AU - Lichtermann, Lynne

AU - Kitabchi, Abbas E.

AU - Day, Jackie

AU - Lambeth, Helen

AU - Force, Debra

AU - Clark, Debra

AU - Crisler, Andrea

AU - Green, Donna

AU - Cunningham, Gracie

AU - Sun, Maria

AU - Kores, Robert

AU - Rosenthal, Renate

AU - Soberman, Judith

AU - Jeffery, Robert W.

AU - Thorson, Carolyn

AU - Bantle, John P.

AU - Redmon, Bruce

AU - Crow, Richard S.

AU - Carls, Jeanne

AU - Campbell, Carolyne

AU - James, La Donna

AU - Ockenden, T.

AU - Brelje, Kerin

AU - Snyder, M. Patricia

AU - Keranen, Amy

AU - Walcheck, Cara

AU - Finch, Emily

AU - Rice, Birgitta

AU - Maddy, Vicki A.

AU - Skarpol, Tricia

AU - Pi-Sunyer, Xavier

AU - Patricio, Jennifer

AU - Mayer, Jennifer

AU - Heshka, Stanley

AU - Pal, Carmen

AU - Holowaty, Mary Anne

AU - Hirsch, Diane

AU - Wadden, Thomas A.

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AU - Nevitt, Michael

AU - Schwartz, Ann

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AU - Farach, Cecilia

AU - Harrison, Barbara

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AU - Hubbard, Van S.

AU - Evans, Mary

AU - Cooper, Lawton S.

AU - Obarzanek, Eva

AU - Simons-Morton, Denise

AU - Williamson, David F.

AU - Gregg, Edward W.

PY - 2008

Y1 - 2008

N2 - Many protocols have been used in clinical and research settings for collecting systolic blood pressure (SBP) measurements to calculate the ankle-brachial index (ABI); however, it is not known how useful it is to replicate measurements and which measures best reflect cardiovascular risk. Standardized measurements of ankle and arm SBP from 5140 overweight or obese individuals with type 2 diabetes were used to estimate sources of variation. Measurement characteristics of leg-specific ABI, as calculated using a standard algorithm based on the highest SBP of the dorsalis pedis or posterior tibial arteries, were projected using simulations. Coefficients of variability ranged from 2% to 3% when single SBP measurements were used and ABI was overestimated by 2-3%. Taking two SBP measurements at each site reduced standard errors and bias each by 30-40%. The sensitivity of detecting low ABI ranges exceeded 90% for ABI within 0.05 of the 0.90 clinical cut-point. The average and the minimum of the two (i.e. right and left) leg-specific ABI values had similar U-shaped relationships with Framingham risk scores; however, the average leg ABI had slightly greater precision. Replicating SBP measurements reduces the error and bias of ABI. Averaging leg-specific values may increase power for characterizing cardiovascular disease risk.

AB - Many protocols have been used in clinical and research settings for collecting systolic blood pressure (SBP) measurements to calculate the ankle-brachial index (ABI); however, it is not known how useful it is to replicate measurements and which measures best reflect cardiovascular risk. Standardized measurements of ankle and arm SBP from 5140 overweight or obese individuals with type 2 diabetes were used to estimate sources of variation. Measurement characteristics of leg-specific ABI, as calculated using a standard algorithm based on the highest SBP of the dorsalis pedis or posterior tibial arteries, were projected using simulations. Coefficients of variability ranged from 2% to 3% when single SBP measurements were used and ABI was overestimated by 2-3%. Taking two SBP measurements at each site reduced standard errors and bias each by 30-40%. The sensitivity of detecting low ABI ranges exceeded 90% for ABI within 0.05 of the 0.90 clinical cut-point. The average and the minimum of the two (i.e. right and left) leg-specific ABI values had similar U-shaped relationships with Framingham risk scores; however, the average leg ABI had slightly greater precision. Replicating SBP measurements reduces the error and bias of ABI. Averaging leg-specific values may increase power for characterizing cardiovascular disease risk.

KW - Diagnostic error

KW - Peripheral arterial disease

KW - Sensitivity and specificity

UR - http://www.scopus.com/inward/record.url?scp=58149382575&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=58149382575&partnerID=8YFLogxK

U2 - 10.1177/1358863X08091338

DO - 10.1177/1358863X08091338

M3 - Article

C2 - 18687759

AN - SCOPUS:58149382575

SN - 1358-863X

VL - 13

SP - 225

EP - 233

JO - Vascular Medicine

JF - Vascular Medicine

IS - 3

ER -

Measurement characteristics of the ankle-brachial index: Results from the action for health in diabetes study

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UN SDGs

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