(March 3, 2010 - Insidermedicine)

Ankle brachial index fails to identify patients without cardiovascular disease who might benefit from aspirin therapy, according to a trial published the Journal of the American Medical Association.

Here are some general recommendations for the management of peripheral artery disease from the American Heart Association and American College of Cardiology:

•    Individuals at risk for lower extremity peripheral arterial disease (PAD) should undergo a vascular review of symptoms to assess walking impairment, claudication, ischemic rest pain, and/or the presence of nonhealing wounds.

•    Individuals at risk for lower extremity PAD should undergo comprehensive pulse examination and inspection of the feet.

•    Individuals over 50 years of age should be asked if they have a family history of a first-order relative with an abdominal aortic aneurysm.

Researchers out of the University of Edinburgh representing the Aspirin for Asymptomatic Atherosclerosis trial randomized 28,980 women and men to once daily 100 mg of aspirin or placebo. Participants were aged 50 to 75 and had no known cardiovascular disease. All underwent an ABI screening test which revealed a score of 0.95 or less. The primary endpoint was the composite of initial fatal or nonfatal coronary event of stroke or revascularization.

After a mean follow-up of 8.3 years, 357 participants had a primary endpoint event. There were 13.7 such events per 1,000 person years among those taking aspirin, compared with 13.3 among those taking placebo, a difference that was not statistically significant. Rates of overall vascular events and all-cause mortality were also similar for both groups.

Today's research calls into question the usefulness of measuring ABI among patients without cardiovascular disease, at least for the purposes of identifying those who might benefit from aspirin therapy.