This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in JAMA  Topic Collections  • Cardiovascular Disease/ Myocardial Infarction  • Alert me on articles by topic

Associated Clinical Characteristics and Functional Impairment

Mary McGrae McDermott, MD; Philip Greenland, MD; Kiang Liu, PhD; Jack M. Guralnik, MD, PhD; Michael H. Criqui, MD, MPH; Nancy C. Dolan, MD; Cheeling Chan, MS; Lillian Celic, BS; William H. Pearce, MD; Joseph R. Schneider, MD; Leena Sharma, MD; Elizabeth Clark, MD; Daniel Gibson, BA; Gary J. Martin, MD

JAMA. 2001;286:1599-1606.

Context  Persons with lower-extremity peripheral arterial disease (PAD) are often asymptomatic or have leg symptoms other than intermittent claudication (IC).

Objective  To identify clinical characteristics and functional limitations associated with a broad range of leg symptoms identified among patients with PAD.

Design, Setting, and Participants  Cross-sectional study of 460 men and women with PAD and 130 without PAD, who were identified consecutively, conducted between October 1998 and January 2000 at 3 Chicago-area medical centers.

Main Outcome Measures  Ankle-brachial index score of less than 0.90; scores from 6-minute walk, accelerometer-measured physical activity over 7 days, repeated chair raises, standing balance (full tandem stand), 4-m walking velocity, San Diego claudication questionnaire, Geriatric Depression Score Short-Form, and the Walking Impairment Questionnaire.

Results  All groups with PAD had poorer functioning than participants without PAD. The following values are for patients without IC vs those with IC. Participants in the group with leg pain on exertion and rest (n = 88) had a higher (poorer) score for neuropathy (5.6 vs 3.5; P<.001), prevalence of diabetes mellitus (48.9% vs 26.7%; P<.001), and spinal stenosis (20.8% vs 7.2%; P = .002). The atypical exertional leg pain/carry on group (exertional leg pain other than IC associated with walking through leg pain [n = 41]) and the atypical exertional leg pain/stop group (exertional leg pain other than IC that causes one to stop walking [n = 90]) had better functioning than the IC group. The group without exertional leg pain/inactive (no exertional leg pain in individual who walks 6 blocks per week [n = 28]) and the leg pain on exertion and rest group had poorer functioning than those with IC. Adjusting for age, sex, race, and comorbidities and compared with IC, participants with atypical exertional leg pain/carry on achieved a greater distance on the 6-minute walk (404.3 vs 328.5 m; P<.001) and were less likely to stop during the 6-minute walk (6.8% vs 36%; P = .002). The group with pain on exertion and rest had a slower time for completing 5 chair raises (13.5 vs 11.9 seconds; P = .009), completed the tandem stand less frequently (37.5% vs 60.0%; P = .004), and had a slower 4-m walking velocity (0.80 vs 0.90 m/s; P<.001).

Conclusions  There is a wide range of leg symptoms in persons with PAD beyond that of classic IC. Comorbid disease may contribute to these symptoms in PAD. Functional impairments are found in every PAD symptom group, and the degree of functional limitation varies depending on the type of leg symptom.

Author Affiliations: Departments of Medicine (Drs McDermott, Greenland, Dolan, Sharma, and Martin, and Ms Celic and Mr Gibson), Preventive Medicine (Drs McDermott, Greenland, and Liu, and Ms Chan), and Surgery (Drs Pearce and Schneider), Northwestern University Medical School, Chicago, Ill; Division of Vascular Surgery, Department of Surgery, Evanston/Northwestern Hospital, Evanston, Ill (Dr Schneider); Epidemiology, Demography, and Biometry Program, National Institute on Aging, Bethesda, Md (Dr Guralnik); Department of Family and Preventive Medicine, University of California, San Diego (Dr Criqui); and Division of Vascular Surgery, Department of Surgery, Catholic Health Partners, Chicago, Ill (Dr Clark).

RELATED ARTICLE

October 3, 2001
JAMA. 2001;286(13):1649-1650.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Ethnicity and peripheral artery disease
Bennett et al.
QJM 2008;0:hcn140v1-hcn140.
ABSTRACT | FULL TEXT  

A biomarker panel for peripheral arterial disease
Fung et al.
Vasc Med 2008;13:217-224.
ABSTRACT  

Critical Determinants of Limb Ischemia
Cooke
J Am Coll Cardiol 2008;52:394-396.
FULL TEXT  

The Ankle-to-Arm Blood Pressure Index Predicts Risk of Cardiac Complications After Noncardiac Surgery
Fisher et al.
Anesth. Analg. 2008;107:149-154.
ABSTRACT | FULL TEXT  

Asymptomatic Peripheral Arterial Disease Is Associated With More Adverse Lower Extremity Characteristics Than Intermittent Claudication
McDermott et al.
Circulation 2008;117:2484-2491.
ABSTRACT | FULL TEXT  

Multicenter Randomized Controlled Trial of the Costs and Effects of Noninvasive Diagnostic Imaging in Patients with Peripheral Arterial Disease: The DIPAD Trial
Ouwendijk et al.
Am. J. Roentgenol. 2008;190:1349-1357.
ABSTRACT | FULL TEXT  

Prognostic Value of Functional Performance for Mortality in Patients With Peripheral Artery Disease
McDermott et al.
J Am Coll Cardiol 2008;51:1482-1489.
ABSTRACT | FULL TEXT  

A High Ankle-Brachial Index Is Associated With Increased Cardiovascular Disease Morbidity and Lower Quality of Life
Allison et al.
J Am Coll Cardiol 2008;51:1292-1298.
ABSTRACT | FULL TEXT  

Measurement of Walking Distance and Speed in Patients With Peripheral Arterial Disease: A Novel Method Using a Global Positioning System
Le Faucheur et al.
Circulation 2008;117:897-904.
ABSTRACT | FULL TEXT  

A randomized trial of iloprost in patients with intermittent claudication
Creager et al.
Vasc Med 2008;13:5-13.
ABSTRACT  

The impact of peripheral arterial disease on health-related quality of life in the Peripheral Arterial Disease Awareness, Risk, and Treatment: New Resources for Survival (PARTNERS) Program
Regensteiner et al.
Vasc Med 2008;13:15-24.
ABSTRACT  

Genetic Susceptibility to Peripheral Arterial Disease: A Dark Corner in Vascular Biology
Knowles et al.
Arterioscler. Thromb. Vasc. Bio. 2007;27:2068-2078.
ABSTRACT | FULL TEXT  

Effects of old age on human skeletal muscle energetics during fatiguing contractions with and without blood flow
Lanza et al.
J. Physiol. 2007;583:1093-1105.
ABSTRACT | FULL TEXT  

Baseline Functional Performance Predicts the Rate of Mobility Loss in Persons With Peripheral Arterial Disease
McDermott et al.
J Am Coll Cardiol 2007;50:974-982.
ABSTRACT | FULL TEXT  

Peripheral Arterial Disease: A Guide for Nephrologists
DeLoach and Mohler
CJASN 2007;2:839-846.
ABSTRACT | FULL TEXT  

Persistent Depressive Symptoms and Functional Decline Among Patients With Peripheral Arterial Disease
Ruo et al.
Psychosom. Med. 2007;69:415-424.
ABSTRACT | FULL TEXT  

The Vital Prognosis of Subclavian Stenosis
Aboyans et al.
J Am Coll Cardiol 2007;49:1540-1545.
ABSTRACT | FULL TEXT  

Peripheral Endovascular Revascularization: Some Proof in the Pudding?
Beckman
Circulation 2007;115:550-552.
FULL TEXT  

The Novel Phosphodiesterase Inhibitor NM-702 Improves Claudication-Limited Exercise Performance in Patients With Peripheral Arterial Disease
Brass et al.
J Am Coll Cardiol 2006;48:2539-2545.
ABSTRACT | FULL TEXT  

Lower extremity nerve function in patients with lower extremity ischemia.
McDermott et al.
Arch Intern Med 2006;166:1986-1992.
ABSTRACT | FULL TEXT  

The Effect of Novel Cardiovascular Risk Factors on the Ethnic-Specific Odds for Peripheral Arterial Disease in the Multi-Ethnic Study of Atherosclerosis (MESA)
Allison et al.
J Am Coll Cardiol 2006;48:1190-1197.
ABSTRACT | FULL TEXT  

The United States Preventive Services Task Force Recommendation Statement on Screening for Peripheral Arterial Disease: More Harm Than Benefit?
Beckman et al.
Circulation 2006;114:861-866.
ABSTRACT | FULL TEXT  

Limb hemodynamics are not predictive of functional capacity in patients with PAD
Szuba et al.
Vasc Med 2006;11:155-163.
ABSTRACT  

Physical Activity During Daily Life and Mortality in Patients With Peripheral Arterial Disease
Garg et al.
Circulation 2006;114:242-248.
ABSTRACT | FULL TEXT  

ACC/AHA 2005 Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic): Executive Summary A Collaborative Report From the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): Endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation
Hirsch et al.
J Am Coll Cardiol 2006;47:1239-1312.
FULL TEXT  

Statin Use and Functional Decline in Patients With and Without Peripheral Arterial Disease
Giri et al.
J Am Coll Cardiol 2006;47:998-1004.
ABSTRACT | FULL TEXT  

Does the Clinical Examination Predict Lower Extremity Peripheral Arterial Disease?
Khan et al.
JAMA 2006;295:536-546.
ABSTRACT | FULL TEXT  

Clinical indicators and psychosocial aspects in peripheral arterial disease.
Aquarius et al.
Arch Surg 2006;141:161-166.
ABSTRACT | FULL TEXT  

Physical Performance in Peripheral Arterial Disease: A Slower Rate of Decline in Patients Who Walk More
McDermott et al.
ANN INTERN MED 2006;144:10-20.
ABSTRACT | FULL TEXT  

Exertional Leg Pain in Patients With and Without Peripheral Arterial Disease
Wang et al.
Circulation 2005;112:3501-3508.
ABSTRACT | FULL TEXT  

Diabetes Mellitus, Smoking, and the Risk for Asymptomatic Peripheral Arterial Disease: Whom Should We Screen?
Eason et al.
J Am Board Fam Med 2005;18:355-361.
ABSTRACT | FULL TEXT  

Temporal Trends in the Incidence of Intermittent Claudication from 1950 to 1999
Murabito et al.
Am J Epidemiol 2005;162:430-437.
ABSTRACT | FULL TEXT  

Neural and metabolic mechanisms of excessive muscle fatigue in maintenance hemodialysis patients
Johansen et al.
Am. J. Physiol. Regul. Integr. Comp. Physiol. 2005;289:R805-R813.
ABSTRACT | FULL TEXT  

Peripheral arterial disease symptom subtype and walking impairment
Collins et al.
Vasc Med 2005;10:177-183.
ABSTRACT  

Risk Modification in Patients with Peripheral Arterial Disease: A Retrospective Survey
Youssef et al.
ANGIOLOGY 2005;56:279-287.
ABSTRACT  

MRI measures of perfusion-related changes in human skeletal muscle during progressive contractions
Wigmore et al.
J. Appl. Physiol. 2004;97:2385-2394.
ABSTRACT | FULL TEXT  

Cost-effectiveness of exercise training to improve claudication symptoms in patients with peripheral arterial disease
Treesak et al.
Vasc Med 2004;9:279-285.
ABSTRACT  

Age-related enhancement of fatigue resistance is evident in men during both isometric and dynamic tasks
Lanza et al.
J. Appl. Physiol. 2004;97:967-975.
ABSTRACT | FULL TEXT  

Subclavian artery stenosis: Prevalence, risk factors, and association with cardiovascular diseases
Shadman et al.
J Am Coll Cardiol 2004;44:618-623.
ABSTRACT | FULL TEXT  

Functional Decline in Peripheral Arterial Disease: Associations With the Ankle Brachial Index and Leg Symptoms
McDermott et al.
JAMA 2004;292:453-461.
ABSTRACT | FULL TEXT  

Atherothrombosis: A widespread disease with unpredictable and life-threatening consequences
Viles-Gonzalez et al.
Eur Heart J 2004;25:1197-1207.
ABSTRACT | FULL TEXT  

Prevalence of Lower-Extremity Disease in the U.S. Adult Population >=40 Years of Age With and Without Diabetes: 1999-2000 National Health and Nutrition Examination Survey
Gregg et al.
Diabetes Care 2004;27:1591-1597.
ABSTRACT | FULL TEXT  

Atherosclerotic Vascular Disease Conference: Writing Group V: Medical Decision Making and Therapy
Creager et al.
Circulation 2004;109:2634-2642.
FULL TEXT  

Inflammatory markers, D-dimer, pro-thrombotic factors, and physical activity levels in patients with peripheral arterial disease
McDermott et al.
Vasc Med 2004;9:103-105.
ABSTRACT  

Mandate for Creation of a National Peripheral Arterial Disease Public Awareness Program: An Opportunity to Improve Cardiovascular Health
Hirsch et al.
ANGIOLOGY 2004;55:233-242.
ABSTRACT  

Mandate for Creation of a National Peripheral Arterial Disease Public Awareness Program: An Opportunity to Improve Cardiovascular Health
Hirsch et al.
VASC ENDOVASCULAR SURG 2004;38:121-130.
ABSTRACT  

Randomized trial of AT-1015 for treatment of intermittent claudication. A novel 5-hydroxytryptamine antagonist with no evidence of efficacy
Hiatt et al.
Vasc Med 2004;9:18-25.
ABSTRACT  

The mandate for creation of a national peripheral arterial disease public awareness program: an opportunity to improve cardiovascular health
Hirsch et al.
Vasc Med 2004;9:78-86.
ABSTRACT  

Management of Peripheral Arterial Disease of the Lower Extremities in Elderly Patients
Aronow
J. Gerontol. A Biol. Sci. Med. Sci. 2004;59:M172-177.
ABSTRACT | FULL TEXT  

Cost-effective, Risk-Free, Evidence-Based Medicine--Reply
Belch
Arch Intern Med 2003;163:2795-2796.
FULL TEXT  

Effects of age on human muscle torque, velocity, and power in two muscle groups
Lanza et al.
J. Appl. Physiol. 2003;95:2361-2369.
ABSTRACT | FULL TEXT  

The potential role of angiotensin-converting enzyme inhibition in peripheral arterial disease
Hirsch and Duprez
Vasc Med 2003;8:273-278.
ABSTRACT  

Peripheral Arterial Disease: Identification and Implications
Mohler
Arch Intern Med 2003;163:2306-2314.
ABSTRACT | FULL TEXT  

Functional outcomes and quality of life in peripheral arterial disease: current status
Nehler et al.
Vasc Med 2003;8:115-126.
ABSTRACT  

Statin Use and Leg Functioning in Patients With and Without Lower-Extremity Peripheral Arterial Disease
McDermott et al.
Circulation 2003;107:757-761.
ABSTRACT | FULL TEXT  

Undertreatment of dyslipidemia in peripheral arterial disease and other high-risk populations: an opportunity for cardiovascular disease reduction
Hirsch and Gotto
Vasc Med 2002;7:323-331.
ABSTRACT  

Peripheral Arterial Disease Is Only the Tip of the Atherosclerotic "Iceberg"
Futterman and Lemberg
Am J Crit Care 2002;11:390-394.
FULL TEXT  

The Ankle Brachial Index Is Associated with Leg Function and Physical Activity: The Walking and Leg Circulation Study
McDermott et al.
ANN INTERN MED 2002;136:873-883.
ABSTRACT | FULL TEXT  

Diagnosis and Treatment of Peripheral Arterial Disease
Gaylis et al.
JAMA 2002;287:313-316.
FULL TEXT  

Wide Range of Symptoms for Peripheral Artery Disease
JWatch General 2001;2001:4-4.
FULL TEXT