Suzuki, TakekiZhu, XiaoqianAdabag, SelcukMatsushita, KunihiroButler, Kenneth R.Griswold, Michael E.Alonso, AlvaroRosamond, WayneSotoodehnia, NonaMosley, Thomas H.2024-07-112024-07-112024Suzuki T, Zhu X, Adabag S, et al. Ankle-Brachial Index and Risk of Sudden Cardiac Death in the Community: The ARIC Study. J Am Heart Assoc. 2024;13(6):e032008. doi:10.1161/JAHA.123.032008https://hdl.handle.net/1805/42107Background: Sudden cardiac death (SCD) is a significant global public health problem accounting for 15% to 20% of all deaths. A great majority of SCD is associated with coronary heart disease, which may first be detected at autopsy. The ankle-brachial index (ABI) is a simple, noninvasive measure of subclinical atherosclerosis. The purpose of this study was to examine the relationship between ABI and SCD in a middle-aged biracial general population. Methods and results: Participants of the ARIC (Atherosclerosis Risk in Communities) study with an ABI measurement between 1987 and 1989 were included. ABI was categorized as low (≤0.90), borderline (0.90-1.00), normal (1.00-1.40), and noncompressible (>1.40). SCD was defined as a sudden pulseless condition presumed to be caused by a ventricular tachyarrhythmia in a previously stable individual and was adjudicated by a committee of cardiac electrophysiologists, cardiologists, and internists. Cox proportional hazards models were used to evaluate the associations between baseline ABI and incident SCD. Of the 15 081 participants followed for a median of 23.5 years, 556 (3.7%) developed SCD (1.96 cases per 1000 person-years). Low and borderline ABIs were associated with an increased risk of SCD (demographically adjusted hazard ratios [ HRs ], 2.27 [ 95% CI, 1.64-3.14 ] and 1.52 [ 95% CI, 1.17-1.96 ], respectively) compared with normal ABI. The association between low ABI and SCD remained significant after adjustment for traditional cardiovascular risk factors (HR, 1.63 [ 95% CI, 1.15-2.32 ]). Conclusions: Low ABI is independently associated with an increased risk of SCD in a middle-aged biracial general population. ABI could be incorporated into future SCD risk prediction models.en-USAttribution-NonCommercial-NoDerivatives 4.0 InternationalAnkle–brachial indexEpidemiologySubclinical atherosclerosisSudden cardiac deathArticle