Lower Extremity Peripheral Artery Disease and Quality of Life Among Older Individuals in the Community

Abstract

Background: Evidence regarding the association of lower extremity peripheral arterial disease with quality of life (QOL) is mainly from selected clinical populations or relatively small clinical cohorts. Thus, we investigated this association in community-derived populations.

Methods and results: Using data of 5115 participants aged 66 to 90 years from visit 5 (2011-2013) of the Atherosclerosis Risk in Communities Study, we quantified the associations of ankle-brachial index (ABI) with several QOL parameters, including 12-item Short-Form Health Survey (SF-12), after accounting for potential confounders using linear and logistic regression models. Peripheral arterial disease defined by an ABI <0.90 (n=402), was independently associated with a low SF-12 Physical Component Summary score (-3.26 [95% CI -5.60 to -0.92]), compared to the ABI reference 1.10 to 1.19 (n=1900) but not with the Mental Component Summary score (-0.07 [-2.21 to 2.06]). A low ABI was significantly associated with poorer status of all SF-12 physical domains (physical functioning, role-physical, bodily pain, and general health) but only vitality out of 4 mental domains. Similarly, low ABI values were more consistently associated with other physically related QOL parameters (leisure-time exercise/activity/walking) than mentally related parameters (significant depressive symptoms and hopeless feeling). Lower physical QOL was observed even in individuals with borderline low ABI (0.90 to 0.99; n=426).

Conclusions: Low ABI (even borderline) was independently associated with poor QOL, especially for physical components, in community-dwelling older adults. QOL is a critical element for older adults, and thus, further studies are warranted to assess whether peripheral arterial disease-specific management can improve QOL in older populations.

Keywords: aging; atherosclerosis; epidemiology; peripheral vascular disease; quality of life.

Figure 1

The adjusted difference and 95% CI in quality of life (QOL) scores according to ankle‐brachial index (ABI) categories (Physical/Mental Component Summary from SF‐12). Physical Component Summary and Mental Component Summary scores were adjusted for age, sex, ethnicity, education level, economic status, current smoking/drinking status, body mass index, total cholesterol level, diabetes mellitus, hypertension, history of coronary heart disease, heart failure, and stroke, lung disease, and reduced kidney function.