الفهرس 
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Abstract
Atherosclerosis develops gradually in along subclinical phase and eventually manifested as heart disease or stroke. The currently established methods for such its risk estimation are underused as they require either particular equipment and a specialized user or invasive procedure.
Aim of the Study: to develop a nursing assessment tool for estimating the risk of atherosclerosis and additionally, to assess its validity against a standard measure (duplex ultrasound).
Research Design: A cross-sectional research design was utilized in the current study.
Methods: A randomized sample of 154 subjects, apparently free form vascular diseases and had not taken a drug that could affect blood pressure on the day of the study, aged 35-75 years, attended Minia University Hospital Medical Units, Egypt- during (July to November 2018). Ankle and brachial blood pressures were measured by standardized procedures and carotid intima-media thickness (CIMT) was measured by high-resolution B mode Doppler ultrasound, considering CIMT > 0.9 mm as abnormal.
The tool of Data Collection: one tool of 4 parts was utilized to collect data.
• First part: Bio-Sociodemographic data: It was developed by the researcher after revising extensive literature review to obtain information on the risk factors of atherosclerosis.
• Second part: Biometric measurements: includes anthropometric measurements and BP readings (brachium and ankle).
• Third part: Clinical laboratory measurements: to determine serum levels of lipids, including total cholesterol (TC), high-density lipoprotein cholesterol (HDL), Low-density lipoprotein cholesterol (LDL), triglycerides (TG) and Hemoglobin A1c (HbA1c)
• Fourth part: carotid ultrasonography: carotid intima media thickness was measured by high-resolution B mode Doppler ultrasound and a cut-off value of > 0.9 mm was used as a reference measure.
Results: After stepwise multivariate analysis of [Ankle pulse pressure index (i.e. APPI/SD). Model 2: further adjusted for age (years, sex (male, female, smoking cigarette (ever, never), diabetes mellitus (yes, no), family history of stroke or coronary heart disease (yes, no), body mass index (Kg/m2), total cholesterol level(mg/dl), exercise 30 min a day>5 times/week (yes/no), perceived feeling of stress (no to mild, moderate to severe), and sleep hours per day], the standardized ankle pulse pressure index (APPI) was the only independent pathogenic determinant for CIMT increase (unstandardized coefficient β = .073, p <0.001). APPI-age interaction was significant. APPI predictive value for total population was 0.4422 (AUC=.900, P <0.001) while it was 0.539 (AUC=0.971, P <0.001) for subjects aged < 50years and 0.4388 (AUC=0.922, P <0.001) for those older.
Conclusion: our findings concluded APPI is a valuable predictive tool of subclinical atherosclerosis with a strong predictive capacity to discriminate CIMT > 0.9 mm.
Recommendations:
• Every health care personnel should obtain APPI during routine health examination, on admission, in emergency, in outpatient clinics and even in home for all population aged ≥ 35 years that may uncover subclinical atherosclerosis.
• Replication of the current study on a larger sample size and different reference measure (other than CIMT).to achieve generalizable results.