From the Research
Borderline ankle-brachial index (ABI) values between 0.91 and 0.99 indicate mild peripheral artery disease (PAD) and require consultation with a vascular specialist for further evaluation and management. Management of borderline ABI typically includes lifestyle modifications such as smoking cessation, regular exercise (particularly walking 30 minutes daily), and maintaining a heart-healthy diet low in saturated fats. Medication management often includes antiplatelet therapy (aspirin 81-325mg daily or clopidogrel 75mg daily), statins for cholesterol control (such as atorvastatin 10-80mg daily), and blood pressure management if hypertensive, as supported by studies such as 1 which emphasizes the importance of assessing baseline atherosclerotic cardiovascular disease risk and using global risk scores. For diabetic patients, tight glucose control is essential. Additional testing such as exercise ABI or arterial duplex ultrasound may be recommended to better assess the severity of disease. Borderline ABI values are significant because they indicate early atherosclerotic changes in the arteries of the legs, which correlates with increased risk of cardiovascular events including heart attack and stroke, not just leg problems, as highlighted in studies like 2 which found endothelial dysfunction in a significant portion of individuals with borderline ABI. The cost-effectiveness of using ABI in addition to Framingham risk scoring for cardiovascular risk assessment has been demonstrated, particularly in women, as shown in 3, making it a valuable tool in preventive cardiology. Overall, the management of borderline ABI should prioritize reducing the risk of cardiovascular events through a combination of lifestyle modifications and evidence-based pharmacologic therapies, as guided by the most recent and highest quality studies such as 1.