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. 2010 Jul;58(7):1256-62.
doi: 10.1111/j.1532-5415.2010.02941.x. Epub 2010 Jun 11.

Leg symptom categories and rates of mobility decline in peripheral arterial disease

Mary M McDermott  1 , Luigi Ferrucci, Kiang Liu, Jack M Guralnik, Lu Tian, Yihua Liao, Michael H Criqui
Affiliations

Leg symptom categories and rates of mobility decline in peripheral arterial disease

Mary M McDermott et al. J Am Geriatr Soc. 2010 Jul.

Abstract

Objectives: To determine whether asymptomatic lower extremity peripheral arterial disease (PAD) and leg symptoms other than intermittent claudication (IC) in PAD are associated with faster functional decline than in people with both PAD and IC.

Design: Prospective, observational study.

Setting: Chicago-area medical center.

Participants: Four hundred fifteen people with PAD followed annually for up to 7 years.

Measurements: At baseline, patients with PAD were categorized into symptom categories, including IC; leg pain on exertion and rest; participants who could walk through exertional leg pain (pain/carry on); and participants who never experienced exertional leg pain, even during the 6-minute walk (always asymptomatic). Outcomes included mobility loss (becoming unable to walk one-quarter of a mile or walk up and down one flight of stairs without assistance) and becoming unable to complete the 6-minute walk without stopping. Analyses adjusted for age, sex, comorbidities, ankle brachial index, and other confounders.

Results: Always-asymptomatic participants (hazard ratio (HR)=2.94, 95% confidence interval (CI)=1.39-6.19, P=.005) and those with leg pain on exertion and rest (HR=2.89, 95% CI=1.47-5.68, P=.002) had greater mobility loss than participants with IC. Participants with PAD with leg pain/carry on were less likely (P=.047) to become unable to walk for 6 minutes continuously without stopping than participants with IC.

Conclusion: The ABI identifies patients with asymptomatic PAD and those with atypical leg symptoms who are at risk for greater mobility decline than participants without PAD and participants with PAD with IC.

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Conflict of interest statement

Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper.

Figures

Figure 1
Figure 1. Adjusted Associations of Leg Symptom Categories with Mobility Loss Among Men and Women with and without Peripheral Arterial Disease (N=623)
Analyses adjust for age, sex, race, comorbidities, smoking, body mass index, walking exercise frequency, neuropathy score, use of statins, cilostazol, and pentoxifylline, and ankle brachial index (for analyses of peripheral arterial disease participants only). Mobility loss indicates becoming unable to walk ¼ mile or walk up and down one flight of stairs without assistance.
Figure 1
Figure 1. Adjusted Associations of Leg Symptom Categories with Mobility Loss Among Men and Women with and without Peripheral Arterial Disease (N=623)
Analyses adjust for age, sex, race, comorbidities, smoking, body mass index, walking exercise frequency, neuropathy score, use of statins, cilostazol, and pentoxifylline, and ankle brachial index (for analyses of peripheral arterial disease participants only). Mobility loss indicates becoming unable to walk ¼ mile or walk up and down one flight of stairs without assistance.
Figure 2
Figure 2. Adjusted Associations of baseline Leg Symptom Categories with becoming unable to Walk for Six Minutes Continuously Among Men and Women with and without Peripheral Arterial Disease (N=492)
Analyses adjust for age, sex, race, comorbidities, smoking, body mass index, walking exercise frequency, neuropathy score, use of statins, cilostazol, and pentoxifylline, and ankle brachial index (for analyses of peripheral arterial disease participants only).
Figure 2
Figure 2. Adjusted Associations of baseline Leg Symptom Categories with becoming unable to Walk for Six Minutes Continuously Among Men and Women with and without Peripheral Arterial Disease (N=492)
Analyses adjust for age, sex, race, comorbidities, smoking, body mass index, walking exercise frequency, neuropathy score, use of statins, cilostazol, and pentoxifylline, and ankle brachial index (for analyses of peripheral arterial disease participants only).
Figure 3
Figure 3. Adjusted Associations of Leg Symptom Categories with Experience ≥ a 20% Decline in Six-Minute Walk Performance among Men and Women with and without Peripheral Arterial Disease (N=600)
Analyses adjust for age, sex, race, comorbidities, smoking, body mass index, walking exercise frequency, neuropathy score, use of statins, cilostazol, and pentoxifylline, and ankle brachial index (for analyses of peripheral arterial disease participants only).
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References

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    1. Hirsch AT, Criqui MH, Treat-Jacobson D, et al. Peripheral arterial disease detection, awareness, and treatment in primary care. JAMA. 2001;286:1317–1324. - PubMed
    1. McDermott MM, Greenland P, Liu K, et al. Leg symptoms in peripheral arterial disease. Associated clinical characteristics and functional impairment. JAMA. 2001;286:1599–1606. - PubMed
    1. McDermott MM, Guralnik JM, Ferrucci L, et al. Asymptomatic peripheral arterial disease is associated with more adverse lower extremity characteristics than intermittent claudication. Circulation. 2008;117:2484–2491. - PMC - PubMed
    1. McDermott MM, Liu K, Greenland P, et al. Functional decline in peripheral arterial disease: Associations with the ankle brachial index and leg symptoms. JAMA. 2004;292:453–461. - PubMed

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