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Leg Symptom Categories and Rates of Mobility Decline in Peripheral Arterial Disease

Authors

  • Mary M. McDermott MD,

    1. From the Departments of *Medicine and Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Longitudinal Studies Section, Clinical Research Branch, National Institute on Aging, Baltimore, Maryland; §Stanford University, Palo Alto, California; and University of California at San Diego, San Diego, California.
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  • Luigi Ferrucci MD, PhD,

    1. From the Departments of *Medicine and Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Longitudinal Studies Section, Clinical Research Branch, National Institute on Aging, Baltimore, Maryland; §Stanford University, Palo Alto, California; and University of California at San Diego, San Diego, California.
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  • Kiang Liu PhD,

    1. From the Departments of *Medicine and Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Longitudinal Studies Section, Clinical Research Branch, National Institute on Aging, Baltimore, Maryland; §Stanford University, Palo Alto, California; and University of California at San Diego, San Diego, California.
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  • Jack M. Guralnik MD, PhD,

    1. From the Departments of *Medicine and Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Longitudinal Studies Section, Clinical Research Branch, National Institute on Aging, Baltimore, Maryland; §Stanford University, Palo Alto, California; and University of California at San Diego, San Diego, California.
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  • Lu Tian ScD,

    1. From the Departments of *Medicine and Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Longitudinal Studies Section, Clinical Research Branch, National Institute on Aging, Baltimore, Maryland; §Stanford University, Palo Alto, California; and University of California at San Diego, San Diego, California.
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  • Yihua Liao MS,

    1. From the Departments of *Medicine and Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Longitudinal Studies Section, Clinical Research Branch, National Institute on Aging, Baltimore, Maryland; §Stanford University, Palo Alto, California; and University of California at San Diego, San Diego, California.
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  • Michael H. Criqui MD, MPH

    1. From the Departments of *Medicine and Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Longitudinal Studies Section, Clinical Research Branch, National Institute on Aging, Baltimore, Maryland; §Stanford University, Palo Alto, California; and University of California at San Diego, San Diego, California.
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  • Presented at the National Society of General Internal Medicine meeting, Miami, Florida, May 2009.

Address correspondence to Mary M. McDermott, 750 North Lake Shore Drive, 10th Floor, Chicago, IL 60611. E-mail: mdm608@northwestern.edu

Abstract

OBJECTIVES: 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.

DESIGN: Prospective, observational study.

SETTING: Chicago-area medical center.

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

MEASUREMENTS: 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.

CONCLUSION: 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.

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