Leg symptom categories and rates of mobility decline in peripheral arterial disease.
OBJECTIVE
To determine whether asymptomatic lower extremity peripheral arterial disease (PAD) and leg symptoms other than intermittent claudication (IC) in PAD are associated with faster functional decline than in people with both PAD and IC.


METHODS
Prospective, observational study.


METHODS
Chicago-area medical center.


METHODS
Four hundred fifteen people with PAD followed annually for up to 7 years.


METHODS
At baseline, patients with PAD were categorized into symptom categories, including IC; leg pain on exertion and rest; participants who could walk through exertional leg pain (pain/carry on); and participants who never experienced exertional leg pain, even during the 6-minute walk (always asymptomatic). Outcomes included mobility loss (becoming unable to walk one-quarter of a mile or walk up and down one flight of stairs without assistance) and becoming unable to complete the 6-minute walk without stopping. Analyses adjusted for age, sex, comorbidities, ankle brachial index, and other confounders.


RESULTS
Always-asymptomatic participants (hazard ratio (HR)=2.94, 95% confidence interval (CI)=1.39-6.19, P=.005) and those with leg pain on exertion and rest (HR=2.89, 95% CI=1.47-5.68, P=.002) had greater mobility loss than participants with IC. Participants with PAD with leg pain/carry on were less likely (P=.047) to become unable to walk for 6 minutes continuously without stopping than participants with IC.


CONCLUSIONS
The ABI identifies patients with asymptomatic PAD and those with atypical leg symptoms who are at risk for greater mobility decline than participants without PAD and participants with PAD with IC.
McDermott
Mary M
MM
Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA. mdm608@northwestern.edu
Ferrucci
Luigi
L
Liu
Kiang
K
Guralnik
Jack M
JM
Tian
Lu
L
Liao
Yihua
Y
Criqui
Michael H
MH
D000368:Aged; D000369:Aged, 80 and over; D055109:Ankle Brachial Index; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007383:Intermittent Claudication / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology*; D007866:Leg / Q000098:blood supply*; D008297:Male; D051346:Mobility Limitation; D010146:Pain / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D016491:Peripheral Vascular Diseases / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology*; D011446:Prospective Studies; D013997:Time Factors