A risk score for predicting peripheral arterial disease in individuals 75 years or older.
BACKGROUND
The prevalence of peripheral arterial disease (PAD) in the elderly is high. Most are asymptomatic and the sensitivity of the physical exam is low. In Brazil, little is known in regard to PAD risk factors in the elderly.


OBJECTIVE
To identify risk factors for PAD among elderly individuals (> or = 75 years) in the community and to develop a prediction score.


METHODS
Cross-sectional, prospective, community-based study nested within a cohort study ("Epidoso"). A total of 176 individuals were assessed. PAD was defined as an ankle-brachial index < or = 0.9. Risk factors associated with PAD were entered into a multivariate logistic regression model. Statistical modeling was used to formulate a score according to the likelihood of PAD. A p value <0.05 was significant.


RESULTS
PAD was present in 36.4% of participants. Abnormal pedal pulses, hypertension, cigarette smoking, and complain of leg pain/discomfort in either leg on walking were predictors of PAD. Based on the coefficients of the logistic regression, these variables were given scores of 13, 9, 5 and 5, respectively. A cutoff point >18 points defined the "high risk" individuals and yielded sensitivity, specificity, positive predictive value and negative predictive value of 85.9%, 71.4%, 63.2% and 89.9%, respectively. Receiver-operator characteristic analysis yielded area under curve of 85%, indicating excellent discrimination and goodness-of-fit statistics indicated excellent calibration (p=0.639).


CONCLUSIONS
Because of its good performance, the proposed score can become a simple and useful tool to identify elderly community residents at higher risk of PAD who should be considered for further investigation.
Makdisse
Marcia
M
Universidade Federal de São Paulo, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil. mmakdisse@yahoo.com
Ramos
Luiz Roberto
LR
Moreira
Frederico
F
Oliveira
Anderson
A
Berwanger
Otavio
O
Moscardi
Alcione
A
Junqueira
Virginia
V
Rodrigues
Evandro
E
Carvalho
Antonio Carlos
AC
D000368:Aged; D000369:Aged, 80 and over; D000842:Ankle / Q000098:blood supply*; D001794:Blood Pressure / Q000502:physiology*; D001916:Brachial Artery / Q000503:physiopathology; D001938:Brazil / Q000453:epidemiology; D002784:Cholesterol / Q000097:blood; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications; D007383:Intermittent Claudication / Q000175:diagnosis; D007866:Leg; D008297:Male; D010146:Pain / Q000209:etiology; D016491:Peripheral Vascular Diseases / Q000175:diagnosis* / Q000209:etiology; D011674:Pulse; D012907:Smoking / Q000009:adverse effects; D016138:Walking
D002784:Cholesterol