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Published on: October 22, 2014
Peripheral vascular disease: consequence for survival and association with risk factors in the Speedwell prospective
D Bainton1, P Sweetnam, I Baker
1Department of Epidemiology and Community Medicine, University of Wales College of Medicine, Heath Park, Cardiff.
Insights
Intermittent claudication significantly increases mortality risk, primarily from circulatory causes. Smoking is a major risk factor for developing this condition.
Area of Science:
- Epidemiology
- Vascular Medicine
- Public Health
Background:
- Intermittent claudication (IC) is a symptom of peripheral artery disease, characterized by calf pain during ambulation.
- Understanding the prevalence, incidence, and mortality associated with IC is crucial for public health initiatives.
Purpose of the Study:
- To determine the prevalence and incidence of intermittent claudication in middle-aged men.
- To investigate the mortality risks associated with intermittent claudication.
- To identify key risk factors for the development of intermittent claudication.
Main Methods:
- Prospective cohort study (Speedwell study) involving men aged 45-59.
- Standardized questionnaire for calf pain during walking and measurement of vascular risk factors.
- Follow-up for 11 years to ascertain mortality and re-examination every three years.
Main Results:
- Prevalence of IC increased with age, reaching 2.9% in men aged 60-64.
- Annual incidence ranged from 0.3% to 0.5% across age groups.
- IC strongly correlated with ischemic heart disease (angina odds ratio 6.7).
- Men with IC had a 3.8-fold increased risk of death, mainly from circulatory causes.
- Smoking was the most significant risk factor, followed by blood pressure, glucose, triglycerides, and white cell count.
Conclusions:
- Intermittent claudication is a potent indicator of elevated mortality risk.
- The increased mortality is only partially explained by co-existing ischemic heart disease.
Objective:
To measure the prevalence and incidence of intermittent claudication, to describe the mortality associated wtih the condition, and to assess the relevance of risk factors for vascular disease.
Design:
A standard questionnaire on calf pain when walking was given in the prospective Speedwell study, and a range of risk factors were measured. The men were re-examined at intervals of three years, and deaths over 11 years were identified.
Setting:
The general population.
Participants:
All men aged 45 to 59 registered with 16 general practitioners.
Results:
The prevalence of intermittent claudication increased from almost nil at ages 45-49 to 2.9% at ages 60-64. The annual incidence increased from 0.3% in the youngest men to 0.5% in those in their early 60s. Intermittent claudication was related to the existence of ischaemic heart disease, particularly angina, at the first examination. The relative odds of men with angina developing intermittent claudication was 6.7 (95% confidence interval (95% CI) 3.6 to 12.4). The risk of death in men with intermittent claudication was substantially raised. After standardisation for age and smoking the relative odds of death was 3.8 (95% CI 2.2 to 6.5). The excess was entirely from circulatory causes. Systolic blood pressure, fasting plasma glucose, triglycerides, and white cell count were all independently associated with the development of intermittent claudication, but the most striking association was with smoking.
Conclusions:
Intermittent claudication is an indicator for a very high risk of death. This is only partly explained by its strong association with ischaemic heart disease.
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