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A high normal ankle–brachial index combined with a high pulse wave velocity is associated with cerebral microbleeds

Kinjo, Yoshino; Ishida, Akio; Kinjo, Kozen; Ohya, Yusuke

doi: 10.1097/HJH.0000000000000993

Objectives: Arterial stiffness is associated with the pathogenesis of cerebral microbleeds (CMBs). The ankle–brachial index (ABI) is used to predict arterial stiffness. We hypothesized that the increase in ABI with age occurs as a result of increasing arterial stiffness and wave reflection, and is thus associated with target organ damage. The aim of this study was to investigate the relationship between ABI, brachial–ankle pulse wave velocity (baPWV), and CMBs.

Methods: We recruited 990 cardiovascular disease-free and stroke-free participants [median age 53 (24–86) years, 531 were woman] who underwent brain MRI, ABI, and baPWV at a health checkup.

Results: The prevalence of CMBs was 4%. Both ABI (1.14 vs. 1.10) and baPWV (17.29 vs. 14.68 m/s) were higher in participants with CMBs than those without. Cutoff values of ABI and baPWV for the presence of CMBs were 1.12 and 16.07 m/s, respectively. Multivariate logistic regression analysis showed that ABI at least 1.12 [odds ratio (OR) 2.57, 95% confidence interval (CI) 1.30–5.37, P < 0.05] and baPWV at least 16.07 m/s (OR 2.08, 95% CI 1.02–4.38, P < 0.05) were independently associated with CMBs. Moreover, the combination of ABI at least 1.12 and baPWV at least 16.07 m/s was strongly associated with CMBs (OR 5.26, 95% CI 1.93–16.92, P < 0.05).

Conclusion: A high normal ABI, combined with a high baPWV, was strongly associated with CMBs in a screened Japanese cohort, suggesting a novel use for ABI as a predictor for target organ damage.

aDepartment of Cardiovascular Medicine, Nephrology and Neurology, University of the Ryukyus Graduate School of Medicine

bOkinawa Health Promotion Foundation, Okinawa, Japan

Correspondence to Akio Ishida, MD, PhD, Department of Cardiovascular Medicine, Nephrology and Neurology, University of the Ryukyus Graduate School of Medicine, 207 Uehara, Nishihara-cho, Okinawa 903-0215, Japan. Tel: +81 98 895 3331; fax: +81 98 895 1416; e-mail:

Abbreviations: ABI, ankle–brachial index; baPWV, brachial–ankle pulse wave velocity; CMB, cerebral microbleed; SBI, silent brain infarction; WMHs, white matter hyperintensities

Received 10 December, 2015

Revised 25 March, 2016

Accepted 9 May, 2016

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