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  • Citing articles on Web of Science (67)  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Topic Collections  • Cardiovascular System  • Cardiovascular Disease/ Myocardial Infarction  • Alert me on articles by topic  Social Bookmarking   What's this?

Associations With the Ankle Brachial Index and Leg Symptoms

Mary McGrae McDermott, MD; Kiang Liu, PhD; Philip Greenland, MD; Jack M. Guralnik, MD, PhD; Michael H. Criqui, MD, MPH; Cheeling Chan, MS; William H. Pearce, MD; Joseph R. Schneider, MD, PhD; Luigi Ferrucci, MD, PhD; Lillian Celic, BS; Lloyd M. Taylor, MD; Ed Vonesh, PhD; Gary J. Martin, MD; Elizabeth Clark, MD

JAMA. 2004;292:453-461.

Context  Among individuals with lower-extremity peripheral arterial disease (PAD), specific leg symptoms and the ankle brachial index (ABI) are cross-sectionally related to the degree of functional impairment. However, relations between these clinical characteristics and objectively measured functional decline are unknown.

Objective  To define whether PAD, ABI, and specific leg symptoms predict functional decline at 2-year follow-up.

Design, Setting, and Participants  Prospective cohort study among 676 consecutively identified individuals (aged 55 years) with and without PAD (n = 417 and n = 259, respectively), with baseline functional assessments occurring between October 1, 1998, and January 31, 2000, and follow-up assessments scheduled 1 and 2 years thereafter. PAD was defined as ABI less than 0.90, and participants with PAD were categorized at baseline into 1 of 5 mutually exclusive symptom groups.

Main Outcome Measures  Mean annual changes in 6-minute walk performance and in usual-paced and fast-paced 4-m walking velocity, adjusted for age, sex, race, prior-year functioning, comorbid diseases, body mass index, pack-years of cigarette smoking, and patterns of missing data.

Results  Lower baseline ABI values were associated with greater mean (95% confidence interval) annual decline in 6-minute walk performance (–73.0 [–142 to –4.2] ft for ABI <0.50 vs –58.8 [–83.5 to –34.0] ft for ABI 0.50 to <0.90 vs –12.6 [–40.3 to 15.1] ft for ABI 0.90-1.50, P = .02). Compared with participants without PAD, PAD participants with leg pain on exertion and rest at baseline had greater mean annual decline in 6-minute walk performance (–111 [–173 to –50.0] ft vs –8.67 [–36.9 to 19.5] ft, P = .004), usual-pace 4-meter walking velocity (–0.06 [–0.09 to –0.02] m/sec vs –0.01 (–0.03 to 0.003] m/sec, P = .02), and fastest-pace 4-meter walking velocity (–0.07 [–0.11 to –0.03] m/sec vs –0.02 [–0.04 to –0.006] m/sec, P = .046). Compared with participants without PAD, asymptomatic PAD was associated with greater mean annual decline in 6-minute walk performance (–76.8 (–135 to –18.6] ft vs –8.67 (–36.9 to 19.5] ft, P = .04) and an increased odds ratio for becoming unable to walk for 6 minutes continuously (3.63; 95% confidence interval, 1.58-8.36; P = .002).

Conclusions  Baseline ABI and the nature of leg symptoms predict the degree of functional decline at 2-year follow-up. Previously reported lack of worsening in claudication symptoms over time in patients with PAD may be more related to declining functional performance to than lack of disease progression.

Author Affiliations: Departments of Medicine (Drs McDermott, Greenland, and Martin and Ms Celic) and Preventive Medicine (Drs McDermott, Liu, Greenland, and Vonesh and Ms Chan) and Division of Vascular Surgery, Department of Surgery (Drs Pearce and Schneider), Northwestern University Feinberg School of Medicine, Chicago, Ill; Laboratory of Epidemiology, Demography, and Biometry (Dr Guralnik) and Laboratory of Clinical Epidemiology (Dr Ferrucci), National Institute on Aging, Bethesda, Md; Department of Family and Preventive Medicine, University of California at San Diego (Dr Criqui); Division of Vascular Surgery, Department of Surgery, Evanston/Northwestern Hospital, Evanston, Ill (Dr Schneider); Oregon Health and Science University, Portland (Dr Taylor); and Division of Vascular Surgery, Department of Surgery, Catholic Health Partners, Chicago, Ill (Dr Clark).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Intra-Arterial Transplantation of Adult Bone Marrow Cells Restores Blood Flow and Regenerates Skeletal Muscle in Ischemic Limbs
Liu et al.
VASC ENDOVASCULAR SURG 2009;43:433-443.
ABSTRACT  

The role of biomarkers and genetics in peripheral arterial disease.
McDermott and Lloyd-Jones
J Am Coll Cardiol 2009;54:1228-1237.
ABSTRACT | FULL TEXT  

Pathophysiological Changes in Calf Muscle Predict Mobility Loss at 2-Year Follow-Up in Men and Women With Peripheral Arterial Disease
McDermott et al.
Circulation 2009;120:1048-1055.
ABSTRACT | FULL TEXT  

Multifactorial determinants of functional capacity in peripheral arterial disease: uncoupling of calf muscle perfusion and metabolism.
Anderson et al.
J Am Coll Cardiol 2009;54:628-635.
ABSTRACT | FULL TEXT  

Vascular Disease Burden and In-Hospital Outcomes Among Patients Undergoing Percutaneous Coronary Intervention in New York State
Berger et al.
Circ Cardiovasc Interv 2009;2:317-322.
ABSTRACT | FULL TEXT  

Associations of Borderline and Low Normal Ankle-Brachial Index Values With Functional Decline at 5-Year Follow-Up: The WALCS (Walking and Leg Circulation Study)
McDermott et al.
J Am Coll Cardiol 2009;53:1056-1062.
ABSTRACT | FULL TEXT  

Rethinking the Morbidity of Peripheral Arterial Disease and the "Normal" Ankle-Brachial Index
Gornik
J Am Coll Cardiol 2009;53:1063-1064.
FULL TEXT  

Heart Disease and Stroke Statistics--2009 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee
WRITING GROUP MEMBERS et al.
Circulation 2009;119:e21-e181.
FULL TEXT  

Physical Activity During Daily Life and Functional Decline in Peripheral Arterial Disease
Garg et al.
Circulation 2009;119:251-260.
ABSTRACT | FULL TEXT  

Treadmill Exercise and Resistance Training in Patients With Peripheral Arterial Disease With and Without Intermittent Claudication: A Randomized Controlled Trial
McDermott et al.
JAMA 2009;301:165-174.
ABSTRACT | FULL TEXT  

Diabetes-Related Microvascular and Macrovascular Diseases in the Physical Therapy Setting
Cade
ptjournal 2008;88:1322-1335.
ABSTRACT | FULL TEXT  

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

Plasma Levels of Soluble Tie2 and Vascular Endothelial Growth Factor Distinguish Critical Limb Ischemia From Intermittent Claudication in Patients With Peripheral Arterial Disease
Findley et al.
J Am Coll Cardiol 2008;52:387-393.
ABSTRACT | FULL TEXT  

The Relation of Peripheral Arterial Disease to Leg Force, Gait Speed, and Functional Dependence Among Older Adults
Kuo and Yu
Journals of Gerontology Series A: Biological Sciences and Medical Sciences 2008;63:384-390.
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  

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  

Heart Disease and Stroke Statistics--2008 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee
Writing Group Members et al.
Circulation 2008;117:e25-e146.
FULL TEXT  

Biomarkers of Inflammation and Thrombosis as Predictors of Near-Term Mortality in Patients with Peripheral Arterial Disease: A Cohort Study
Vidula et al.
ANN INTERN MED 2008;148:85-93.
ABSTRACT | FULL TEXT  

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  

Is a Simple Biomarker for Peripheral Arterial Disease on the Horizon?
Annex
Circulation 2007;116:1346-1348.
FULL TEXT  

{beta}2-Microglobulin as a Biomarker in Peripheral Arterial Disease: Proteomic Profiling and Clinical Studies
Wilson et al.
Circulation 2007;116:1396-1403.
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  

Elevated Levels of Inflammation, D-Dimer, and Homocysteine Are Associated With Adverse Calf Muscle Characteristics and Reduced Calf Strength in Peripheral Arterial Disease
McDermott et al.
J Am Coll Cardiol 2007;50:897-905.
ABSTRACT | FULL TEXT  

Type-D Personality and Ankle Brachial Index as Predictors of Impaired Quality of Life and Depressive Symptoms in Peripheral Arterial Disease
Aquarius et al.
Arch Surg 2007;142:662-667.
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  

Optimal assessment of baseline treadmill walking performance in claudication clinical trials
Brass et al.
Vasc Med 2007;12:97-103.
ABSTRACT  

Intermittent Claudication
White
NEJM 2007;356:1241-1250.
FULL TEXT  

Heart Disease and Stroke Statistics--2007 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee
Rosamond et al.
Circulation 2007;115:e69-e171.
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  

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  

Delayed Calf Muscle Phosphocreatine Recovery After Exercise Identifies Peripheral Arterial Disease
Isbell et al.
J Am Coll Cardiol 2006;47:2289-2295.
ABSTRACT | FULL TEXT  

Functional decline in patients with and without peripheral arterial disease: predictive value of annual changes in levels of C-reactive protein and d-dimer.
McDermott et al.
Journals of Gerontology Series A: Biological Sciences and Medical Sciences 2006;61:374-379.
ABSTRACT | FULL TEXT  

Peripheral Arterial Disease in Patients With Diabetes
Marso and Hiatt
J Am Coll Cardiol 2006;47:921-929.
ABSTRACT | 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  

Heart Disease and Stroke Statistics--2006 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee
Thom et al.
Circulation 2006;113:e85-e151.
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  

Mobility Limitation Among Persons Aged >=40 Years With and Without Diagnosed Diabetes and Lower Extremity Disease--United States, 1999-2002
JAMA 2006;295:29-30.
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  

Longitudinal Predictors of Reduced Mobility and Physical Disability in Patients With Type 2 Diabetes: The Fremantle Diabetes Study
Bruce et al.
Diabetes Care 2005;28:2441-2447.
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  

Review: Physical disability and the cumulative impact of diabetes in older adults
Gregg and Caspersen
British Journal of Diabetes & Vascular Disease 2005;5:13-17.
ABSTRACT  

Functional Decline in Asymptomatic People with PAD
Journal Watch Cardiology 2004;2004:2-2.
FULL TEXT