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(Circulation. 2008;117:2484-2491.)
© 2008 American Heart Association, Inc.

Epidemiology

Asymptomatic Peripheral Arterial Disease Is Associated With More Adverse Lower Extremity Characteristics Than Intermittent Claudication

Mary M. McDermott, MD; Jack M. Guralnik, MD, PhD; Luigi Ferrucci, MD, PhD; Lu Tian, ScD; Kiang Liu, PhD; Yihua Liao, MS; David Green, MD, PhD; Robert Sufit, MD; Frederick Hoff, MD; Takashi Nishida, MD; Leena Sharma, MD; William H. Pearce, MD; Joseph R. Schneider, MD, PhD; Michael H. Criqui, MD, MPH

From the Feinberg School of Medicine, Northwestern University, Chicago, Ill (M.M.M., L.T., K.L., Y.L., D.G., R.S., F.H., T.N., L.S., W.H.P.); National Institute on Aging, Bethesda, Md (J.M.G., L.F.); Central DuPage Hospital, Winfield, Ill (J.R.S.); and University of California at San Diego, San Diego (M.H.C.).

Correspondence to Mary M. McDermott, MD, 750 N Lake Shore Dr, 10th Floor, Chicago, IL 60611. E-mail mdm608{at}northwestern.edu

Received August 27, 2007; accepted March 5, 2008.

Background— This study assessed functional performance, calf muscle characteristics, peripheral nerve function, and quality of life in asymptomatic persons with peripheral arterial disease (PAD).

Methods and Results— PAD participants (n=465) had an ankle brachial index <0.90. Non-PAD participants (n=292) had an ankle brachial index of 0.90 to 1.30. PAD participants were categorized into leg symptom groups including intermittent claudication (n=215) and always asymptomatic (participants who never experienced exertional leg pain, even during the 6-minute walk; n=72). Calf muscle was measured with computed tomography. Analyses were adjusted for age, sex, race, ankle brachial index, comorbidities, and other confounders. Compared with participants with intermittent claudication, always asymptomatic PAD participants had smaller calf muscle area (4935 versus 5592 mm²; P<0.001), higher calf muscle percent fat (16.10% versus 9.45%; P<0.001), poorer 6-minute walk performance (966 versus 1129 ft; P=0.0002), slower usual-paced walking speed (P=0.0019), slower fast-paced walking speed (P<0.001), and a poorer Short-Form 36 Physical Functioning score (P=0.016). Compared with an age-matched, sedentary, non-PAD cohort, always asymptomatic PAD participants had smaller calf muscle area (5061 versus 5895 mm²; P=0.009), poorer 6-minute walk performance (1126 versus 1452 ft; P<0.001), and poorer Walking Impairment Questionnaire speed scores (40.87 versus 57.78; P=0.001).

Conclusions— Persons with PAD who never experience exertional leg symptoms have poorer functional performance, poorer quality of life, and more adverse calf muscle characteristics compared with persons with intermittent claudication and a sedentary, asymptomatic, age-matched group of non-PAD persons.

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CLINICAL PERSPECTIVE

Related Article:

Clinical Summaries
Circulation 2008 117: 2425-2427. [Full Text]