In Reply: In the Aspirin for Asymptomatic Atherosclerosis trial,1 aspirin was not demonstrated to be effective in decreasing cardiovascular events in participants free of CVD but with a screening-detected ABI at 0.95 or lower. Similarly, the Prevention of Progression of Arterial Disease and Diabetes (POPADAD) trial found no benefit of aspirin in diabetic patients free of CVD with a screening ABI at 0.99 or lower.2 In both of these trials, a screening ABI used for study inclusion was not demonstrated to identify a population that would benefit from aspirin therapy. To help determine the appropriate use of ABI (or any screening diagnostic test), a better understanding of whether the test will lead to a change in management is needed.
Berger JS. Aspirin for Prevention of Cardiovascular Events in Individuals With Low Ankle Brachial Index—Reply. JAMA. 2010;303(21):2136-2137. doi:10.1001/jama.2010.699