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Intermittent claudication, heart disease risk factors, and mortality. The Whitehall Study
G D Smith1, M J Shipley, G Rose
1Department of Epidemiology and Population Sciences, London School of Hygiene and Tropical Medicine, England.
Insights
Intermittent claudication, a condition affecting leg circulation, is linked to higher mortality. Early detection through simple questionnaires can aid cardiovascular risk assessment.
Area of Science:
- Epidemiology
- Cardiovascular Health
- Public Health
Background:
- Intermittent claudication (IC) is a symptom of peripheral artery disease, characterized by leg pain during exertion.
- The prognostic significance of probable and possible IC, as identified by questionnaires, requires further elucidation.
- Understanding the mortality patterns associated with IC is crucial for public health initiatives.
Purpose of the Study:
- To investigate the association between probable and possible intermittent claudication and all-cause and cause-specific mortality.
- To determine if intermittent claudication is an independent predictor of mortality after adjusting for known cardiovascular risk factors.
Main Methods:
- Prospective cohort study utilizing data from the Whitehall study.
- 18,388 participants aged 40-64 years completed a questionnaire to assess intermittent claudication.
- Follow-up over 17 years to ascertain mortality data.
Main Results:
- 0.8% and 1% of subjects had probable and possible intermittent claudication, respectively.
- Within 17 years, 38% of probable and 40% of possible cases died.
- Both probable and possible IC were associated with increased cardiovascular and all-cause mortality, independent of traditional risk factors.
Conclusions:
- Intermittent claudication is independently associated with increased mortality.
- Simple questionnaires can effectively identify individuals with IC for cardiovascular risk assessment.
- IC is not a rare condition and warrants inclusion in screening programs.
Abstract:
In the Whitehall study, 18,388 subjects aged 40-64 years completed a questionnaire on intermittent claudication. Of these subjects, 0.8% (147) and 1% (175) were deemed to have probable intermittent claudication and possible intermittent claudication, respectively. Within the 17-year follow-up period, 38% and 40% of the probable and possible cases, respectively, died. Compared with subjects without claudication, the probable cases suffered increased mortality rates due to coronary heart disease and cerebrovascular disease, but the mortality rate due to noncardiovascular causes was not increased. Possible cases demonstrated increased mortality rates due to cardiovascular and noncardiovascular causes. This difference in mortality pattern may be due to chance. Possible and probable cases still showed increased cardiovascular and all-cause mortality rates after adjusting for coronary risk factors (cardiac ischemia at baseline, systolic blood pressure, plasma cholesterol concentration, smoking behavior, employment grade, and degree of glucose intolerance). Intermittent claudication is independently related to increased mortality rates. It is not a rare condition, and simple questionnaires exist for its detection. The latter can be usefully incorporated in cardiovascular risk assessment and screening programs.