PAD With Elevated ABI an Independent Risk Factor for Heart Failure

Hands holding chest with symptom heart attack disease
Researchers sought to determine if peripheral artery disease is an independent risk factor for heart failure.

Peripheral artery disease (PAD) increases the risk for heart failure, particularly when the individual has elevated ankle brachial index (ABI), according to study results presented at the American Heart Association (AHA) Scientific Sessions 2021, held from November 13 to 15, 2021.

The retrospective analysis included 36,816 adults without previous heart failure, all of whom underwent ABI measurement between 1995 and 2020. Follow-up lasted a median of 4.21 years. The study participants were stratified into 3 ABI groups: PAD with low ABI (<1.10), healthy ABI (1.10-1.39), and PAD with elevated ABI (>1.39). Researchers assessed correlations between PAD and systolic dysfunction (heart failure with reduced ejection fraction [HFrEF]), diastolic dysfunction (heart failure with preserved ejection fraction [HFpEF]), and heart failure. The institutional electronic health record was used for all variables. Hazard ratios (HR) were calculated using multivariable Cox proportional regression with adjustments for sex, age diabetes, hypertension, and current tobacco use.

Heart failure occurred among 5.7% (n=2116) of the study population (HFrEF, n=1110; HFpEF, n=1006). Higher risk for heart failure (HFrEF and HFpEF) occurred in both low- and elevated-ABI groups. Compared with normal ABI, investigators used multivariable analysis that showed a stronger association between greater total heart failure risk and PAD with elevated ABI (HR, 2.36; 95% CI, 2.03-2.73) than PAD with low ABI (HR, 1.56; 95% CI, 1.40-1.74). A stronger association also existed between PAD with elevated ABI and increased HFrEF (HR, 2.37; 95% CI, 1.93-2.92) and HFpEF (HR, 1.82; 95% CI, 1.48-2.25) risk compared with PAD with low ABI (HFrEF, HR, 1.77 [95% CI, 1.52-2.07]; HFpEF, HR, 1.31 [95% CI, 1.12-1.52]).

“PAD, especially with elevated ABI, is an independent risk factor for heart failure even after adjusting for common HF risk factors.” the study authors noted. “Our findings support HF screening in PAD patients, but longitudinal data on HF morbidity and mortality [are] necessary to evaluate the value of this practice.”


Bhatt SK, Murphy K, Sykora D, et al. Peripheral artery disease is an independent risk factor for heart failure by ABI. Presented at: AHA Scientific Sessions 2021; November 13-15, 2021. Poster P2945.