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Intermittent claudication: From its risk factors to its long-term prognosis in men. The Quebec Cardiovascular Study
A St-Pierre1, B Cantin, B Lamarche
1Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec City, Canada.
Insights
Men with intermittent claudication face high cardiovascular disease (CVD) risks, comparable to those with prior myocardial infarction (MI). Key risk factors include smoking, high blood pressure, and diabetes, highlighting the need for proactive management.
Area of Science:
- Cardiovascular Epidemiology
- Vascular Medicine
- Public Health
Background:
- Prospective studies on intermittent claudication's natural history, including risk factors and cardiovascular prognosis, are limited.
- Understanding intermittent claudication is crucial due to its association with significant cardiovascular events.
Purpose of the Study:
- To evaluate the incidence of intermittent claudication in men.
- To identify risk factors associated with developing intermittent claudication.
- To assess the long-term cardiovascular prognosis for men experiencing intermittent claudication.
Main Methods:
- A prospective cohort study of 4376 men aged 35-64, initially free of cardiovascular disease (CVD), was conducted in Quebec City from 1974 to 1998.
- CVD risk factors were assessed in 1974.
- Prognosis was evaluated by comparing event rates between 1985-1998 for men with incident claudication, myocardial infarction (MI) survivors, and men without CVD.
Main Results:
- Over 24 years, 300 men developed intermittent claudication.
- Tobacco use, elevated systolic blood pressure, and diabetes at least doubled the adjusted risk (aRR) of intermittent claudication.
- During a 13-year follow-up, 48.8% of claudicants experienced a new CVD event, a rate similar to myocardial infarction survivors (45.6%) and significantly higher than men without CVD (18.9%).
Conclusions:
- Intermittent claudication significantly increases the risk of future cardiovascular disease (CVD).
- The CVD risk in men with intermittent claudication appears comparable to that of men who have previously had a myocardial infarction (MI).
- These findings underscore the importance of managing intermittent claudication as a critical indicator of cardiovascular risk.
Background:
The natural history of intermittent claudication, from its risk factors to its cardiovascular prognosis, has been reported in few prospective studies.
Objective:
To assess incident intermittent claudication, as well as its risk factors and long-term prognosis in men.
Methods:
A random sample of 4376 men 35 to 64 years of age from Quebec City (Quebec), who were free of cardiovascular disease (CVD), was evaluated in 1974 for CVD risk factors and followed until 1998. To assess the prognosis, the event rates between 1985 and 1998 were computed among men with incident claudication without other CVD, incident survivors of a first myocardial infarction (MI) without other CVD and men free of CVD between 1974 and 1985.
Results:
From 1974 to 1998, 300 men developed intermittent claudication. Tobacco consumption, high systolic blood pressure and diabetes at least doubled the adjusted RR (aRR) of intermittent claudication. In 1985, there were 80 claudicants, 2868 men free of CVD and 68 survivors of a first MI. During the 13-year follow-up, a new CVD occurred in 48.8% of the claudicants, in 18.9% of men without CVD (aRR 2.08; 95% CI 1.48 to 2.90) and in 45.6% of MI survivors (aRR compared with claudicants 1.12; 95% CI 0.69 to 1.79). There was also no significant difference between claudicants and MI survivors for fatal CVD, nonfatal CVD and total mortality.
Conclusions:
Men with intermittent claudication are at high risk for CVD that may be equivalent to men with previous MI.
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