Wang FM, Yang C, Ballew S, et al. - Findings demonstrate an association of low ankle-brachial index (ABI) with coronary heart disease and stroke (CHD/stroke) in older adults without prior atherosclerotic cardiovascular disease (ASCVD) and with higher risk of heart failure (HF) irrespective of baseline ASCVD status. ABI is supported as a risk enhancer for guiding primary cardiovascular prevention and it holds potential value in HF risk evaluation for older adults.

• This analysis involved 5,003 older adults from ARIC study (4,160 without prior ASCVD [median age 74 years], and 843 with ASCVD visit [median age 76 years]).

• An association of a low ABI ≤0.9 (vs ABI 1.11–1.20) with both CHD/stroke and HF (adjusted hazard ratios 2.40 and 2.23, respectively) was evident in those without a history of ASCVD.

• Low ABI was not significantly related to CHD/stroke, but was with HF (7.12) in participants with prior ASCVD.

• Independent links of ABI categories of 0.9–1.2 and > 1.3 with elevated HF risk was found.

• Significant improvement in risk discrimination of CHD/stroke was achieved with ABI, beyond traditional risk factors, in those without ASCVD and HF, irrespective of baseline ASCVD.