Is the Ankle Brachial Pressure Index an Independent Predictor for Cardiovascular Morbidity and Death in the Asymptomatic Population? A Systematic Review and Meta-analysis
Bibliographic record
Abstract
OBJECTIVE: This study aimed to assess whether the ankle brachial pressure index (ABPI) is independently associated with cardiovascular morbidity and mortality in the asymptomatic general population. DATA SOURCES: Ovid MEDLINE, Embase, CINAHL, and Cochrane databases. REVIEW METHODS: Studies assessing ABPI in a general population with > 30 days follow up were included. A random effects meta-analysis was completed following PRISMA guidelines (PROSPERO: CRD42022383573). Study quality was assessed using the Newcastle-Ottawa Scale, and certainty was assessed through Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Outcomes included major cardiovascular events, cardiovascular death, coronary events, cerebrovascular events, and all cause death. RESULTS: Twenty-five studies from 23 cohorts were included (20 prospective, four retrospective, and one propensity matched), representing 181 598 individuals. An ABPI < 0.9 was statistically significantly associated with higher cardiovascular mortality (hazard ratio [HR] 2.04, 95% confidence interval [CI] 1.70 - 2.44, p < .001; GRADE, low certainty), major cardiovascular events (HR 1.74, 95% CI 1.56 - 1.94, p < .001; GRADE, very low certainty), coronary events (HR 2.80, 95% CI 2.11 - 3.70, p < .001; GRADE, low certainty), cerebrovascular events (HR 1.75, 95% CI 1.34 - 2.30, p < .001; GRADE, low certainty), and all cause mortality (HR 1.90, 95% CI 1.71 - 2.10, p < .001; GRADE, very low certainty) compared with a normal ABPI. An ABPI > 1.3 was statistically significantly associated with higher cardiovascular mortality (HR 2.39, 95% CI 2.02 - 2.83, p < .001; GRADE, low certainty) and all cause mortality (HR 1.92, 95% CI 1.54 - 2.39, p < .001; GRADE, very low certainty) compared with a normal ABPI. An ABPI > 1.3 was not statistically significant for major cardiovascular events (HR 1.07, 95% CI 0.74 - 1.55, p = .70; GRADE, low certainty) or cerebrovascular events (HR 1.80, 95% CI 0.91 - 3.58, p = .090; GRADE, very low certainty). CONCLUSION: An abnormal ABPI is associated with higher cardiovascular and all cause mortality rates. Randomised evidence is needed to assess the cost effectiveness, efficacy, and benefits of screening.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.016 | 0.043 |
| Meta-epidemiology (narrow) | 0.002 | 0.002 |
| Meta-epidemiology (broad) | 0.022 | 0.032 |
| Bibliometrics | 0.007 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".