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Tracie C. Collins, MD, MPH; Nancy J. Petersen, PhD; Maria Suarez-Almazor, MD, PhD; Carol M. Ashton, MD, MPH

Arch Intern Med. 2003;163:1469-1474.

Background  The purpose of this study was to determine the prevalence of peripheral arterial disease (PAD) in white, African American, and English- and Spanish-speaking Hispanic patients.

Methods  We screened patients older than 50 years for PAD at 4 primary care clinics located in the Houston Veterans Affairs Medical Center and the Harris County Hospital District. The disease was diagnosed by an ankle-brachial index of less than 0.9. Patients also completed questionnaires to ascertain symptoms of intermittent claudication, walking difficulty, medical history, and quality of life.

Results  We enrolled 403 patients (136 whites; 136 African Americans; and 131 Hispanics, 81 of whom were Spanish speaking). The prevalence of PAD was 13.2% among whites, 22.8% among African Americans, and 13.7% among Hispanics (P = .06). African Americans had a significantly higher prevalence of PAD than whites and Hispanics combined (P = .02). Among all patients who were diagnosed as having PAD on the basis of their ankle-brachial index, only 5 (7.5%) had symptoms of intermittent claudication.

Conclusions  Peripheral arterial disease is a prevalent illness in the primary care setting. Its prevalence varies by race and is higher in African Americans than in whites and Hispanics. Relative to the prevalence of PAD, the prevalence of intermittent claudication is low. Since measurement of the ankle-brachial index is not part of the routine clinic visit, many patients with PAD are not diagnosed unless they develop symptoms of intermittent claudication. Because of this, it is likely that many patients remain undiagnosed. Efforts are needed to improve PAD detection in the primary care setting.

From the Houston Center for Quality of Care and Utilization Studies, Houston Veterans Affairs Medical Center, and the Section of Health Services Research, Baylor College of Medicine, Houston, Tex. The authors have no relevant financial interest in this article.

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