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Intermittent claudication and risk of cardiovascular events
G Brevetti1, V D Martone, S Perna
1Department of Medicine, University Federico II, Napoli, Italy.
Insights
Intermittent claudication patients face significant cardiovascular risks, with the ankle-brachial pressure index (ABPI) predicting future events. Lower ABPI values indicate higher cardiovascular morbidity, highlighting its importance in risk assessment.
Area of Science:
- Vascular Medicine
- Cardiovascular Epidemiology
- Clinical Outcomes Research
Background:
- Intermittent claudication (IC) is a common symptom of peripheral artery disease (PAD).
- The natural history and cardiovascular risks associated with IC require further elucidation.
- Understanding long-term outcomes is crucial for patient management.
Purpose of the Study:
- To investigate the natural history of intermittent claudication.
- To determine the cumulative cardiovascular morbidity in patients with IC.
- To identify predictors of cardiovascular events in this population.
Main Methods:
- Prospective follow-up of 110 patients with intermittent claudication for a mean of 24.4 months.
- Assessment of cardiovascular events, including nonfatal events and mortality.
- Utilized Cox proportional-hazards analysis and treadmill testing to evaluate risk factors and functional capacity.
Main Results:
- Cumulative cardiovascular morbidity reached 29% at 3 years.
- Initial ankle-brachial pressure index (ABPI) was a significant predictor of nonfatal cardiovascular events (p<0.002).
- Patients with ABPI <0.50 had a 60% cardiovascular morbidity rate, compared to 12% for ABPI >0.70 (p<0.005).
- Critical limb ischemia was infrequent, with low rates of amputation and arterial reconstruction.
Conclusions:
- Cardiovascular morbidity is a significant concern in patients with intermittent claudication.
- The ankle-brachial pressure index (ABPI) is a valuable tool for identifying high-risk patients.
- The prognosis for the claudicant limb itself is relatively benign, but systemic cardiovascular risk must be addressed.
Abstract:
To determine the natural history of intermittent claudication, 110 patients were followed up for a mean period of 24.4 +/- 1.2 months. Four patients died during the follow-up. Of the survivors, 24 experienced a nonfatal cardiovascular event, myocardial infarction being the most frequent. Cumulative cardiovascular morbidity was 29% at 3 years. Cox proportional-hazards analysis showed initial ankle-brachial pressure index (ABPI) as a significant predictor for nonfatal cardiovascular events (p<0.002). With an initial ABPI >0.70, cardiovascular morbidity rate was 12% compared with 33% for those with initial ABPI ranging from 0.70 to 0.50, and 60% for those with ABPI <0.50 (p<0.005). Critical limb ischemia occurred in only four patients, amputation was required in two, and arterial reconstruction in five. Of the 85 patients who participated in the treadmill test, maximum walking capacity worsened in 26% and improved in 27%. This study elucidates the neglected area of cardiovascular morbidity in intermittent claudication. It has shown that ABPI identifies a subgroup of patients for whom the risk of cardiovascular events is especially pronounced. On the other hand, based on objective evaluation of the patient status, the relatively benign prognosis for the claudicant limb has been confirmed.