Intermittent claudication in the Erfurt Male Cohort (ERFORT) Study: its determinants and the impact on mortality. A population-based prospective cohort study with 30 years of follow-up.
OBJECTIVE
Intermittent claudication (IC) is the most common symptom of peripheral arterial disease and is associated with an increased mortality. Within the Erfurt Male Cohort (ERFORT) Study, one of the most long-lasting population-based prospective cohort studies in Europe, we investigated (i) which variables predict the development of incident IC determined by the WHO Rose questionnaire over a period of 15 years and (ii) if IC is predictive for 30 years all-cause mortality.


METHODS
The baseline survey examined a random population-based sample of 1160 males aged 40-59 years with three follow-up examinations 5, 10 and 15 years after enrollment using each time the Rose questionnaire.


RESULTS
An adjusted Cox regression analysis revealed smoking (HR (95% CI), 2.20 (1.24-3.92), p=0.01), diabetes mellitus (HR (95% CI), 4.68 (1.61-13.63), p=0.01) and coronary heart disease (HR (95% CI), 2.74 (1.08-6.96), p=0.03) to be significantly associated with incident IC. Participants with an IC had an significantly increased age-adjusted 30 years all-cause mortality (HR (95% CI), 1.56 (1.16-2.10), p=0.003). This association remained still significantly predictive after adjustment for other cardiovascular risk factors.


CONCLUSIONS
Mainly smoking and diabetes mellitus are associated with incident IC. A positive Rose questionnaire is a strong predictor for all-cause mortality over 30 years. The simplicity of their use makes questionnaires highly attractive for identification of high-risk patients in primary health care.
Kollerits
Barbara
B
Division of Genetic Epidemiology, Department of Medical Genetics, Molecular and Clinical Pharmacology, Innsbruck Medical University, Schöpfstr. 41, A-6020 Innsbruck, Austria.
Heinrich
Joachim
J
Pichler
Michaela
M
Rantner
Barbara
B
Klein-Weigel
Peter
P
Wölke
Gabriele
G
Brasche
Sabine
S
Strube
Gert
G
Kronenberg
Florian
F
D000328:Adult; D002423:Cause of Death; D015331:Cohort Studies; D003327:Coronary Disease / Q000401:mortality; D003920:Diabetes Mellitus / Q000401:mortality*; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000401:mortality; D015994:Incidence; D007383:Intermittent Claudication / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D016016:Proportional Hazards Models; D012307:Risk Factors; D012907:Smoking / Q000401:mortality*; D011795:Surveys and Questionnaires