Assessment of the prevalence of atherosclerotic lower limb arteriopathy inFrance with systolic index in a vascular risk population

Objective: Obliterative arteriopathy of the lower limbs is a severe disease . History taking often underestimates prevalence. in studies using the Rose questionnaire and examining the prevalence of symptomatic arteriopathy def ined by the presence of intermittent claudication, prevalence has been rath er constant, around 2% in the general population in industrialized countrie s. A more clinical approach searching for physical anomalies (absence of di stal pulse) generally gives higher rates. The most recent data led us to co nduct a study focusing on screening for arterial disease using the systolic index (the systolic index is the ratio between the ankle and humeral systo lic pressure). A systolic index below 0.90 would be a sign of defective per fusion, increasing in severity with poorly compensated arterial lesions. Method: A survey was performed in a random sample of 150 practitioners usin g an allocation procedure to the nearest colleague in case of refusal. A da ta sheet containing demographic data and the main risk factors was establis hed for each consulting patient aged from 40 to 80 years. The systolic inde x was measured in each patient with at least one vascular risk or who consu lted for pain in the lower limbs. A simple sequential non-randomized patien t recruitment scheme was used. Results: The survey population included nearly 9,000 patients (8,987), 46% men and 54% women, mean age 64 years (table I). Patient risk factors includ ing smoking, diabetes, hypertension, and physical exercise were adjusted fo r sex and age (table II-VI, IX). The systolic index was recorded in 41% of the population who had a vascular risk factor. Among these patients, nearly one-fourth had a systolic index under 0.90, giving a prevalence in the sam ple population of 11% (table VII). This rate was also assessed by age and s ex (table VIII). Logistic regression evidenced a prognostic value (fig. 1) for smoking, hypertension and sedentary activity, and to a lesser extent, f or age and sex. There was a significant difference by latitude, patients li ving in northern France having a higher risk than those living in southern France (table X). In addition, there was a relationship between the systoli c index and spontaneous complaint, showing that this complaint is poorly sp ecific for arterial disease (table XI, XII). Conclusion : This epidemiological approach to arteriopathy implemented by g eneral practitioners searching for patients with a vascular profile and mea suring systolic index is a novel method. It gave an estimation of prevalenc e at 11% in the French population, a rate compatible with that reported by other international teams. The method also allowed an analysis of factors a ffecting the rate.