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Mary McGrae McDermott, MD; Shruti Mehta, BA; Philip Greenland, MD

Arch Intern Med. 1999;159:387-392.

Background  Epidemiological data show that most community-dwelling men and women with lower-extremity peripheral arterial disease (PAD) do not have typical symptoms of intermittent claudication. We compared the prevalence of intermittent claudication, leg symptoms other than intermittent claudication, and absence of exertional leg symptoms between patients with PAD identified from a blood flow laboratory (group 1), patients with PAD in a general medicine practice (group 2), and control patients without PAD (group 3).

Methods  Numbers of participants in groups 1, 2, and 3 were 137, 26, and 105, respectively. Patients with previously diagnosed PAD were excluded from groups 2 and 3. All participants underwent ankle-brachial index measurement and were administered the San Diego claudication questionnaire to assess leg symptoms.

Results  Within groups 1, 2, and 3, prevalences of intermittent claudication were 28.5% (n=39), 3.8% (n=1), and 3.8% (n=4), respectively. Prevalences of exertional leg symptoms other than intermittent claudication were 56.2% (n=77), 42.3% (n=11), and 19.0% (n=20), respectively. Absence of exertional leg symptoms was reported by 15.3% (n=21), 53.8% (n=14), and 77.1% (n=81), respectively. Among patients with PAD, older age, male sex, diabetes mellitus, and group 2 vs group 1 status were associated independently with absence of exertional leg symptoms in multivariable regression analysis. Lower ankle-brachial index levels and group 1 vs group 2 status were associated with intermittent claudication.

Conclusions  Clinical manifestations of PAD are diverse, particularly among patients identified by ankle-brachial index screening. Exertional leg symptoms other than intermittent claudication are common in PAD. Patients with PAD who are older, male, diabetic, or identified with ankle-brachial index screening in a primary care setting are more likely to have asymptomatic PAD.

From the Division of General Internal Medicine (Dr McDermott), Department of Medicine (Ms Mehta), and Department of Preventive Medicine (Drs McDermott and Greenland), Northwestern University Medical School, Chicago, Ill.

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