Prevalence and Significance of Unrecognized Lower Extremity Peripheral Arterial Disease in General Medicine Practice

• Published in: Journal of general internal medicine Vol. 16; no. 6; pp. 384 - 390
• Main Authors: McGrae McDermott, Mary, Kerwin, Diana R., Liu, Kiang, Martin, Gary J., O'Brien, Erin, Kaplan, Heather, Greenland, Philip
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Boston, MA, USA Blackwell Science Inc 01-06-2001; Springer; Springer Nature B.V
• Subjects: Age Factors; Aged; Ankle; ankle brachial index; Aspirin; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Cigarette smoking; Confidence intervals; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Female; functional impairment; Health care facilities; Humans; intermittent claudication; Internal medicine; Laboratories; Leg; Leg - blood supply; Leg - physiopathology; Male; Medical sciences; Medicine; Men; Middle Aged; Original; Patients; peripheral arterial disease; Peripheral Vascular Diseases - physiopathology; Prevalence; primary care; Regression Analysis; Signs and symptoms; Statistical analysis; Walking; Women; Arterial disease; Vascular disease; Human; Estimation error; Symptomatology; Primary health care; Lower limb; Cardiovascular disease; Occlusive arterial disease; Critical study; Diagnosis; Incidence
• ISSN: 0884-8734; 1525-1497
• DOI: 10.1046/j.1525-1497.2001.016006384.x

OBJECTIVE: To determine the prevalence of unrecognized lower extremity peripheral arterial disease (PAD) among men and women aged 55 years and older in a general internal medicine (GIM) practice and to identify characteristics and functional performance associated with unrecognized PAD.
DESIGN: Cross‐sectional.
SETTING: Academic medical center.
PARTICIPANTS: We identified 143 patients with known PAD from the noninvasive vascular laboratory, and 239 men and women aged 55 and older with no prior PAD history from a GIM practice. Group 1 consisted of patients with PAD consecutively identified from the noninvasive vascular laboratory (n = 143). Group 2 included GIM practice patients found to have an ankle brachial index less than 0.90, consistent with PAD (n = 34). Group 3 consisted of GIM practice patients without PAD (n = 205).
MEASUREMENTS AND MAIN RESULTS: Leg functioning was assessed with the 6‐minute walk, 4‐meter walking velocity, and Walking Impairment Questionnaire (WIQ). Of GIM practice patients, 14% had unrecognized PAD. Only 44% of patients in Group 2 had exertional leg symptoms. Distances achieved in the 6‐minute walk were 1,130, 1,362, and 1,539 feet for Groups 1, 2, and 3, respectively, adjusting for age, gender, and race (P < .001). The degree of difficulty walking due to leg symptoms as reported on the WIQ was comparable between Groups 2 and 3 and significantly greater in Group 1 than Group 2. In multiple logistic regression analysis including Groups 2 and 3, current cigarette smoking was associated independently with unrecognized PAD (odds ratio [OR], 6.82; 95% confidence interval [95% CI], 1.55 to 29.93). Aspirin therapy was nearly independently associated with absence of PAD (OR, 0.37; 95% CI, 0.12 to 1.12).
CONCLUSION: Unrecognized PAD is common among men and women aged 55 years and older in GIM practice and is associated with impaired lower extremity functioning. Ankle brachial index screening may be necessary to diagnose unrecognized PAD in a GIM practice.