Natural history of claudication: long-term serial follow-up study of 1244 claudicants

Area of Science:

• Vascular Medicine
• Peripheral Artery Disease
• Clinical Epidemiology

Background:

• Claudication, a symptom of peripheral artery disease, significantly impacts quality of life.
• Understanding the natural history and risk factors for severe outcomes like ischemic rest pain (IRP) and ischemic ulceration (IU) is crucial for patient management.
• Previous studies have varied in duration and scope, necessitating long-term, prospective investigations.

Purpose of the Study:

• To delineate the natural history of claudication over an extended period.
• To identify independent risk factors associated with the progression to IRP and IU in patients with claudication.
• To provide data for improved prediction of clinical outcomes in this patient population.

Main Methods:

• A prospective cohort study involving 1244 men diagnosed with claudication.
• Serial data collection over 15 years, including demographics, clinical risk factors, and ankle-brachial index (ABI).
• Kaplan-Meier analysis and proportional hazards modeling were employed to identify predictors of IRP and IU.

Main Results:

• The average ankle-brachial index (ABI) declined by 0.014 annually, and self-reported walking distance decreased by 9.2 yards per year.
• The cumulative 10-year risk for developing ischemic ulceration (IU) was 23%, and for ischemic rest pain (IRP) was 30%.
• Multivariate analysis identified diabetes mellitus (DM) and a lower ABI as significant independent predictors for both IRP and IU.

Conclusions:

• This 15-year study provides the longest serial follow-up data on claudication to date.
• Diabetes Mellitus (DM) and ankle-brachial index (ABI) are critical clinical factors associated with the progression to severe ischemic complications.
• These findings can aid in predicting the clinical trajectory of patients with claudication and inform risk stratification strategies.