Clinical Characteristics of Lower-Extremity Edema in Stage A Cardiovascular Disease Status Defined by the ACC/AHA 2001 Chronic Heart Failure Guidelines


  • A version of this study was presented in part at the Heart Failure 2012 conference, Belgrade, Serbia, May 19–22, 2012. The author has no funding, financial relationships, or conflicts of interest to disclose.

Address for correspondence: Hajime Kataoka, MD Division of Internal Medicine Nishida Hospital Oita, Japan



Checking for lower-extremity edema is important for diagnosing, monitoring, and managing heart failure (HF). However, the characteristics of this sign in the early stages of cardiovascular disease (stage A, as defined by the American College of Cardiology/American Heart Association 2001 chronic HF guidelines) have not been adequately explored.


We hypothesized that stage A HF patients (at risk for HF) are free from leg edema.


After the exclusion of patients with high serum creatinine levels (≥1.2 mg/dL), abnormal electrocardiogram rhythm, and/or comorbid critical disease(s), we studied the prevalence and predictors for leg edema in 274 subjects at risk for heart failure but without structural heart disease or symptoms of HF.


The overall prevalence of lower-extremity edema was 33 of 274 patients (12.0%; 95% confidence interval: 8.2%-15.9%). In most patients (29/33, 88%), the leg edema involved only the ankle and foot. Compared with patients without leg edema (n = 241), those with leg edema (n = 33) were older (age, 74 ± 11 7 vs 69 ± 12 years, P = 0.006), more likely to present with pulmonary crackles (52% vs 31%, P < 0.03), and more likely to have varicose veins (55% vs 15%, P < 0.001). Leg edema and varicose veins coexisted in 19 (58%) patients, of whom 16 patients were women. On multivariate analysis, the presence of varicose veins was the only independent predictor of the appearance of bilateral leg edema (odds ratio: 8.18, 95% confidence interval: 3.92-17.1, P < 0.001).


A mild degree of leg edema is not uncommon in patients at risk for HF. Recognition of this phenomenon might be important for evaluation, monitoring, and self-care of HF patients.