Low pulse‐wave amplitude during reactive leg hyperaemia: an independent, early marker for ischaemic heart disease and death Results from the 21‐year follow‐up of the prospective cohort study ‘Men born in 1914’, Malmö, Sweden

Abstract

Objective. To study the incidence of myocardial infarction, all-cause mortality and mortality from ischaemic heart disease in relation to arterial leg blood flow determined by venous occlusion plethysmography of the calf. Design. A prospective cohort study ‘Men born in 1914’. Setting. Malmö, a city in southern Sweden with 256000 inhabitants, and a single referral hospital. Subjects. Six-hundred and thirty-six 55-year-old men, randomly selected from the general population. None of them had signs or symptoms of leg artery disease. Main outcome measures. All-cause mortality, morbidity and mortality from ischaemic heart disease during 21 years of follow-up following the initial examination in 1968. Results. A low pulse-wave amplitude (i.e. < 5 mm) during reactive hyperaemia was, independently of other known arteriosclerotic risk factors, associated with a higher cardiac event rate of 37.1% (relative risk: 2.2; 95% CI: 1.3–3.6) and a higher all-cause mortality rate of 62.9% (relative risk: 1.7; 95% CI: 1.2–2.4) during 21 years of follow-up. No other plethysmographically recorded variable was associated with an increased mortality and cardiac event rate. Conclusions. The plethysmographically recorded pulse-wave amplitude during reactive hyperaemia can be used as an early independent marker to identify individuals at risk of developing ischaemic heart disease and death at an early age.