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.
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.
Authors: M H Criqui; R D Langer; A Fronek; H S Feigelson; M R Klauber; T J McCann; D Browner Journal: N Engl J Med Date: 1992-02-06 Impact factor: 91.245
Authors: G H Guyatt; M J Sullivan; P J Thompson; E L Fallen; S O Pugsley; D W Taylor; L B Berman Journal: Can Med Assoc J Date: 1985-04-15 Impact factor: 8.262
Authors: S Z Goldhaber; J E Manson; M J Stampfer; F LaMotte; B Rosner; J E Buring; C H Hennekens Journal: Lancet Date: 1992-07-18 Impact factor: 79.321
Authors: Jennifer M Yentes; Jessie M Huisinga; Sara A Myers; Iraklis I Pipinos; Jason M Johanning; Nicholas Stergiou Journal: J Appl Biomech Date: 2012-05 Impact factor: 1.833
Authors: Marty D Spranger; Abhinav C Krishnan; Phillip D Levy; Donal S O'Leary; Scott A Smith Journal: Am J Physiol Heart Circ Physiol Date: 2015-09-04 Impact factor: 4.733
Authors: Parveen K Garg; Lu Tian; Michael H Criqui; Kiang Liu; Luigi Ferrucci; Jack M Guralnik; Jin Tan; Mary M McDermott Journal: Circulation Date: 2006-07-03 Impact factor: 29.690
Authors: Mary M McDermott; Jack M Guralnik; Lu Tian; Luigi Ferrucci; Kiang Liu; Yihua Liao; Michael H Criqui Journal: J Am Coll Cardiol Date: 2007-08-20 Impact factor: 24.094
Authors: Mary M McDermott; Jack M Guralnik; Lu Tian; Kiang Liu; Luigi Ferrucci; Yihua Liao; Leena Sharma; Michael H Criqui Journal: J Am Coll Cardiol Date: 2009-03-24 Impact factor: 24.094
Authors: Mary M McDermott; Jack M Guralnik; Luigi Ferrucci; Lu Tian; Kiang Liu; Yihua Liao; David Green; Robert Sufit; Frederick Hoff; Takashi Nishida; Leena Sharma; William H Pearce; Joseph R Schneider; Michael H Criqui Journal: Circulation Date: 2008-05-05 Impact factor: 29.690
Authors: Astrid Fahrleitner; Harald Dobnig; Andrea Obernosterer; Ernst Pilger; Georg Leb; Kurt Weber; Stefan Kudlacek; Barbara M Obermayer-Pietsch Journal: J Gen Intern Med Date: 2002-09 Impact factor: 5.128