Thigh and buttock exertional pain for the diagnosis of peripheral arterial disease.

OBJECTIVES: To evaluate the prevalence of both non-calf intermittent claudication (IC) and classic IC in patients with no known atherosclerotic disease, and their accuracy to detect peripheral arterial disease (PAD). DESIGN: Cross sectional, observational study conducted at 96 internal medicine services. MATERIALS AND METHODS: 1487 outpatients with no known atherosclerotic disease, and either diabetes or a SCORE risk estimation of at least 3% were enrolled. IC was assessed using the Edinburgh Claudication Questionnaire and PAD was confirmed by an ankle-brachial index (ABI) <0.9. RESULTS: Overall, 7.2% met criteria of classic and 5.8% of non-calf IC. PAD was diagnosed in 393 cases (26.4%). In these PAD patients, 17.8% exhibited classic and 13.2% non-calf IC. Both calf and non-calf IC had similar overall accuracy for detecting PAD. Considering both categories as a whole, the sensitivity of IC to predict a low ABI was 31% and the specificity 93%. CONCLUSIONS: Non-calf IC is comparable to classic IC for the diagnosis of PAD in patients with no known arterial disease. The systematic implementation of Edinburgh Claudication Questionnaire could be a valuable call-to-action to improve clinical evaluation of PAD, bearing in mind that PAD detected by either non-calf or classic IC must be confirmed by ABI testing.

[Clinical value of the ankle-brachial index in patients at risk of cardiovascular disease but without known atherothrombotic disease: VITAMIN study]. / Valor de la determinación del índice tobillo-brazo en pacientes de riesgo vascular sin enfermedad aterotrombótica conocida: estudio VITAMIN.

INTRODUCTION AND OBJECTIVES: Detecting peripheral arterial disease by measuring the ankle-brachial index can help identify asymptomatic patients with established disease. We investigated the prevalence of peripheral arterial disease (i.e., an ankle-brachial index <0.9) and its potential clinical and therapeutic impact in patients with no known arterial disease who were seen at internal medicine departments. METHODS: This multicenter, cross-sectional, observational study included patients at risk of cardiovascular disease who were selected on the basis of age, gender and the presence of conventional risk factors. No patient was known to have arterial disease. RESULTS: The study included 493 patients, 174 (35%) of whom had diabetes, while 321 (65%) did not. Only 16% were in a low-risk category according to their Framingham score. An ankle-brachial index <0.9 was observed in 27.4%, comprising 37.9% of those with diabetes and 21.3% of those without. Multiple logistic regression analysis showed that the risk factors associated with an ankle-brachial index <0.9 were age, diabetes, and hypercholesterolemia. There was a significant relationship between the ankle-brachial index and Framingham risk categories. Therapeutically, only 21% of patients with an ankle brachial index <0.9 were taking antiplatelet drugs. Overall, 20% had a low-density lipoprotein cholesterol concentration <100 mg/dl and 52% had a concentration <130 mg/dl. Some 42% had arterial blood pressures below 140/90 mm Hg. CONCLUSIONS: Asymptomatic peripheral arterial disease was detected in a high proportion of patients with an intermediate or high cardiovascular disease risk. The ankle-brachial index should be measured routinely in patients at risk of cardiovascular disease who are seen at internal medicine departments.

Valor de la determinación del índice tobillo-brazo en pacientes de riesgo vascular sin enfermedad aterotrombótica conocida: estudio VITAMIN / Clinical value of the ankle-brachial indexin patients at risk of cardiovascular disease but without known atherothrombotic disease: VITAMIN study

Introducción y objetivos. La detección de la enfermedad arterial periférica, mediante el índice tobillo-brazo, permite identificar a los pacientes asintomáticos con una lesión establecida. Investigamos la prevalencia de enfermedad arterial periférica (índice tobillo-brazo < 0,9) en sujetos sin enfermedad arterial conocida atendidos en el ámbito de medicina interna y su potencial impacto clínico-terapéutico. Métodos. Estudio multicéntrico, transversal, observacional en el que se incluyó a pacientes con potencial riesgo cardiovascular, seleccionados en función de la edad, el sexo y la presencia de factores de riesgo convencionales, pero sin enfermedad arterial conocida. Resultados. Se evaluaron 493 casos, de los que 174 eran diabéticos (35%) y 321, no diabéticos (65%). Sólo un 16% presentó un riesgo bajo según la ecuación de Framingham. Del total de la muestra, el índice tobillo-brazo fue < 0,9 en el 27,4% (el 37,9% de los diabéticos y el 21,3%, de los no diabéticos). En el análisis multivariable, los parámetros que se asociaron con un índice tobillo-brazo < 0,9 fueron la edad, la diabetes mellitus y la hipercolesterolemia. Se objetivó una relación significativa entre las categorías de riesgo de Framingham y el índice tobillo-brazo. Al considerar a los pacientes con un índice tobillo-brazo < 0,9, sólo el 21% recibía tratamiento antiagregante, el 20% presentaba valores de colesterol unido a lipoproteínas de baja densidad (LDL) < 100 mg/dl (el 52% con LDL < 130 mg/dl) y el 42% tenía unos valores de presión arterial < 140/90 mmHg. Conclusiones. En una proporción elevada de pacientes con riesgo cardiovascular intermedio o alto se detecta enfermedad arterial periférica asintomática. El índice tobillo-brazo debería medirse sistemáticamente en enfermos con riesgo vascular, evaluados en el ámbito de la medicina interna

Introduction and objectives. Detecting peripheral arterial disease by measuring the ankle-brachial index can help identify asymptomatic patients with established disease. We investigated the prevalence of peripheral arterial disease (i.e., an ankle-brachial index <0.9) and its potential clinical and therapeutic impact in patients with no known arterial disease who were seen at internal medicine departments. Methods. This multicenter, cross-sectional, observational study included patients at risk of cardiovascular disease who were selected on the basis of age, gender and the presence of conventional risk factors. No patient was known to have arterial disease. Results. The study included 493 patients, 174 (35%) of whom had diabetes, while 321 (65%) did not. Only 16% were in a low-risk category according to their Framingham score. An ankle-brachial index <0.9 was observed in 27.4%, comprising 37.9% of those with diabetes and 21.3% of those without. Multiple logistic regression analysis showed that the risk factors associated with an ankle-brachial index <0.9 were age, diabetes, and hypercholesterolemia. There was a significant relationship between the ankle-brachial index and Framingham risk categories. Therapeutically, only 21% of patients with an ankle brachial index <0.9 were taking antiplatelet drugs. Overall, 20% had a low-density lipoprotein cholesterol concentration <100 mg/dl and 52% had a concentration <130 mg/dl. Some 42% had arterial blood pressures below 140/90 mm Hg. Conclusions. Asymptomatic peripheral arterial disease was detected in a high proportion of patients with an intermediate or high cardiovascular disease risk. The ankle-brachial index should be measured routinely in patients at risk of cardiovascular disease who are seen at internal medicine departments