title: Association of lower extremity performance with cardiovascular and all-cause mortality in patients with peripheral artery disease: a systematic review and meta-analysis.
abstract: BACKGROUND
  Peripheral artery disease (PAD) is associated with impaired mobility and a high rate of mortality. The aim of this systematic review was to investigate whether reduced lower extremity performance was associated with an increased incidence of cardiovascular and all-cause mortality in people with PAD.
  
  
  RESULTS
  A systematic search of the MEDLINE, EMBASE, SCOPUS, Web of Science, and Cochrane Library databases was conducted. Studies assessing the association between measures of lower extremity performance and cardiovascular or all-cause mortality in PAD patients were included. A meta-analysis was conducted combining data from commonly assessed performance tests. The 10 identified studies assessed lower extremity performance by strength tests, treadmill walking performance, 6-minute walk, walking velocity, and walking impairment questionnaire (WIQ). A meta-analysis revealed that shorter maximum walking distance was associated with increased 5-year cardiovascular (unadjusted RR=2.54, 95% CI 1.86 to 3.47, P<10(-5), n=1577, fixed effects) and all-cause mortality (unadjusted RR=2.23 95% CI 1.85 to 2.69, P<10(-5), n=1710, fixed effects). Slower 4-metre walking velocity, a lower WIQ stair-climbing score, and poor hip extension, knee flexion, and plantar flexion strength were also associated with increased mortality. No significant associations were found for hip flexion strength, WIQ distance score, or WIQ speed score with mortality.
  
  
  CONCLUSIONS
  A number of lower extremity performance measures are prognostic markers for mortality in PAD and may be useful clinical tools for identifying patients at higher risk of death. Further studies are needed to determine whether interventions that improve measures of lower extremity performance reduce mortality.
authors.affiliation: The Vascular Biology Unit, Queensland Research Centre for Peripheral Vascular Disease, School of Medicine and Dentistry, James Cook University, Townsville, Australia (D.R.M., A.J.R., J.V.M., J.G.).
authors.forename: Dylan R
authors.initials: DR
authors.lastname: Morris
authors.affiliation: The Vascular Biology Unit, Queensland Research Centre for Peripheral Vascular Disease, School of Medicine and Dentistry, James Cook University, Townsville, Australia (D.R.M., A.J.R., J.V.M., J.G.).
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Rodriguez
authors.affiliation: The Vascular Biology Unit, Queensland Research Centre for Peripheral Vascular Disease, School of Medicine and Dentistry, James Cook University, Townsville, Australia (D.R.M., A.J.R., J.V.M., J.G.).
authors.forename: Joseph V
authors.initials: JV
authors.lastname: Moxon
authors.affiliation: Psychology Department, University of Stirling, Stirling, United Kingdom (M.A.C.).
authors.forename: Margaret A
authors.initials: MA
authors.lastname: Cunningham
authors.affiliation: Feinberg School of Medicine, Northwestern University, Chicago, IL, USA (M.M.M.D.).
authors.forename: Mary M
authors.initials: MM
authors.lastname: McDermott
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, Veterans Affairs Palo Alto Health Care System, Stanford University, Stanford, CA (J.M.).
authors.forename: Jonathan
authors.initials: J
authors.lastname: Myers
authors.affiliation: Division of Vascular Surgery, Stanford University School of Medicine, Stanford, CA (N.J.L.).
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Leeper
authors.affiliation: Faculty of Medicine, Health and Molecular Sciences, James Cook University, Townsville, Australia (R.E.J.).
authors.forename: Rhondda E
authors.initials: RE
authors.lastname: Jones
authors.affiliation: The Vascular Biology Unit, Queensland Research Centre for Peripheral Vascular Disease, School of Medicine and Dentistry, James Cook University, Townsville, Australia (D.R.M., A.J.R., J.V.M., J.G.) Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville, Australia (J.G.).
authors.forename: Jonathan
authors.initials: J
authors.lastname: Golledge
mesh_terms: D002318:Cardiovascular Diseases / Q000401:mortality*; D005080:Exercise Test; D006801:Humans; D035002:Lower Extremity / Q000098:blood supply*; D009026:Mortality; D058729:Peripheral Arterial Disease / Q000503:physiopathology*; D011379:Prognosis; D016138:Walking
keywords: lower extremity performance; mortality; peripheral artery disease