Prevalence of peripheral arterial disease - results of the Heinz Nixdorf recall study.
BACKGROUND
This report presents population-based estimates of the prevalence of peripheral arterial disease (PAD), chronic critical limb ischemia (CLI), and Moenckeberg's medial calcinosis (MC) in Germany.


METHODS
From the year 2000 to 2003, a total of 4,814 subjects aged 45-75 years were included in the study. In 30 of the subjects (0.6%), determination of the ankle brachial index (ABI) was not possible, leaving 4,735 subjects (99.4%) in the data set. PAD was considered present in all subjects with an ABI < 0.9 in one leg, and/or a history of prior treatment for PAD. CLI was considered present if the highest ankle artery pressure measured < 70 mmHg. Prevalence of MC was calculated for ABI cut-off values of 1.3 and 1.5.


RESULTS
The overall prevalence of PAD according to the ABI criteria was 6.4% among men and 5.1% among women. After accounting for history of PAD, the prevalence increased to 8.2% among men and 5.5% among women. Taking the ABI criteria and medical history into account, males had a higher prevalence of PAD, with large increases in males aged 65-69 and 70-75 years. Chronic CLI was rare in the investigated population, and was found in only five older subjects (0.1%). With the criterion of ABI > 1.3, about 13.3% of males and 6.9% of females had MC. In contrast to PAD, the prevalence of MC did not increase with age. With the criterion of ABI > 1.5, MC was present in only 1.1% and 0.5% of men and women, respectively, but only 30 (0.6%) subjects had incompressible ankle arteries with a cuff pressure > 260 mmHg.


CONCLUSIONS
Prevalences of PAD based only on ABI generally underestimate the true prevalence of PAD in population-based studies. CLI predominantly affects older subjects. In addition, cut-off values for MC must be newly determined.
Kröger
Knut
K
Department of Angiology, University Hospital, Essen, Germany. knut.kroeger@uni-essen.de
Stang
Andreas
A
Kondratieva
Jana
J
Moebus
Susanne
S
Beck
Eva
E
Schmermund
Axel
A
Möhlenkamp
Stefan
S
Dragano
Nico
N
Siegrist
Johannes
J
Jöckel
Karl-Heinz
KH
Erbel
Raimund
R