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Annals of Internal Medicine | 2013

The Ankle–Brachial Index for Peripheral Artery Disease Screening and Cardiovascular Disease Prediction Among Asymptomatic Adults: A Systematic Evidence Review for the U.S. Preventive Services Task Force

Jennifer Lin; Carin M Olson; Eric S. Johnson; Caitlyn A. Senger; Clara B Soh; Evelyn P. Whitlock

BACKGROUNDnScreening for peripheral artery disease (PAD) may reduce morbidity and mortality.nnnPURPOSEnTo review the evidence on the ability of the ankle-brachial index (ABI) to predict cardiovascular disease (CVD) morbidity and mortality independent of Framingham Risk Score (FRS) factors in asymptomatic adults and on the benefits and harms of treating screen-detected adults with PAD.nnnDATA SOURCESnMEDLINE and the Cochrane Central Register of Controlled Trials (1996 to September 2012), clinical trial registries, reference lists, and experts.nnnSTUDY SELECTIONnEnglish-language, population-based prognostic studies evaluating the ABI in addition to the FRS and treatment trials or studies of treatment harms in screen-detected adults with PAD.nnnDATA EXTRACTIONnDual quality assessment and abstraction of relevant study details.nnnDATA SYNTHESISnOne large meta-analysis (n = 43 919) showed that the ABI could reclassify 10-year risk for coronary artery disease (CAD), but it did not report measures of appropriate reclassification (the net reclassification improvement [NRI]). Four heterogeneous risk prediction studies showed that the magnitude of the NRI was probably small when the ABI was added to the FRS to predict CAD or CVD events. Of 2 treatment trials meeting inclusion criteria, 1 large trial (n = 3350) showed that low-dose aspirin did not prevent CVD events in persons with a screen-detected low ABI but may have increased the risk for major bleeding events.nnnLIMITATIONSnMost prognostic studies did not allow for calculation of a bias-corrected NRI. Evidence on treatment benefits and harms was limited to aspirin and was scant.nnnCONCLUSIONnAdding the ABI to the FRS probably has limited value for predicting CAD or CVD. Treatment benefits for asymptomatic individuals with screen-detected PAD are not established.nnnPRIMARY FUNDING SOURCEnAgency for Healthcare Research and Quality.


Archive | 2013

LITERATURE SEARCH TERMS

Carin M Olson; Brittany U Burda; Tracy L Beil; Evelyn P Whitlock


Archive | 2013

Systematic Reviews Used for Reference

Jennifer S Lin; Carin M Olson; Eric S. Johnson; Caitlyn A Senger; Clara B Soh; Evelyn P Whitlock


Archive | 2013

Screening for Oral Cancer

Carin M Olson; Brittany U Burda; Tracy L Beil; Evelyn P Whitlock


Archive | 2013

Table 4, Study Characteristics for KQ 4: Does ABI in Generally Asymptomatic Adults Accurately Predict CVD Morbidity and Mortality Independent of FRS?

Jennifer S Lin; Carin M Olson; Eric S. Johnson; Caitlyn A Senger; Clara B Soh; Evelyn P Whitlock


Archive | 2013

Table 14, Study Outcomes for KQs 5 and 6: What Are the Benefits and Harms of Treatment of Generally Asymptomatic Adults With PAD?

Jennifer S Lin; Carin M Olson; Eric S. Johnson; Caitlyn A Senger; Clara B Soh; Evelyn P Whitlock


Archive | 2013

Table 5, Comparison of 10-Year Risks for Hard CAD Events Versus Total CAD Events by FRS Category

Jennifer S Lin; Carin M Olson; Eric S. Johnson; Caitlyn A Senger; Clara B Soh; Evelyn P Whitlock


Archive | 2013

Table 6b, Risk reclassification (by sex) of ABI in addition to Framingham Risk Score (FRS) when collapsing ABI scores 0.91 to 1.40

Jennifer S Lin; Carin M Olson; Eric S. Johnson; Caitlyn A Senger; Clara B Soh; Evelyn P Whitlock


Archive | 2013

Table 8, Baseline Characteristics of ABI Collaboration Cohorts

Jennifer S Lin; Carin M Olson; Eric S. Johnson; Caitlyn A Senger; Clara B Soh; Evelyn P Whitlock


Archive | 2013

Table 10, CAD Outcomes for KQ 4: Does ABI in Generally Asymptomatic Adults Accurately Predict CAD Morbidity and Mortality Independent of FRS?

Jennifer S Lin; Carin M Olson; Eric S. Johnson; Caitlyn A Senger; Clara B Soh; Evelyn P Whitlock

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Evelyn P Whitlock

Agency for Healthcare Research and Quality

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Clara B Soh

Pharmaceutical Research and Manufacturers of America

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Evelyn P. Whitlock

Patient-Centered Outcomes Research Institute

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