Prevalence and significance of unrecognized lower extremity peripheral arterial disease in general medicine practice

Objective: To determine the prevalence of unrecognized lower extremity peri pheral arterial disease (PAD) among men and women aged 55 years and older i n a general internal medicine (GIM) practice and to identify characteristic s and functional performance associated with unrecognized PAD. Design Cross-sectional. Setting: Academic medical center. Participants: We identified 143 patients with known PAD from the noninvasiv e vascular laboratory, and 239 men and women aged 55 years and older with n o prior PAD history from a GIM practice. Group 1 consisted of patients with PAD consecutively identified from the noninvasive vascular laboratory (n = 143). Group 2 included GIM practice patients found to have an ankle brachi al index less than 0.90, consistent with PAD (n = 34). Group 3 consisted of GIM practice patients without PAD (n = 205). Measurements and main results: Leg functioning was assessed with the 6-minu te walk, 4-meter walking velocity, and Walking Impairment Questionnaire (WI Q). Of GIM practice patients, 14% had unrecognized PAD. Only 44% of patient s in Group 2 had exertional leg symptoms. Distances achieved in the 6-minut e walk were 1,130, 1,362, and 1,539 feet for Groups 1, 2, and 3, respective ly, adjusting for age, gender, and race (P <.001). The degree of difficulty walking due to leg symptoms as reported on the WIQ was comparable between Groups 2 and 3 and significantly greater in Group 1 than Group 2. In multip le logistic regression analysis including Groups 2 and 3, current cigarette smoking was independently associated with unrecognized PAD (odds ratio [OR ], 6.82; 95% confidence interval [95% CI], 1.55 to 29.93). Aspirin therapy was nearly independently associated with absence of PAD (OR, 0.37; 95% CI, 0.12 to 1.12). Conclusion: Unrecognized PAD is common among men and women aged 55 years an d older in GIM practice and is associated with impaired lower extremity fun ctioning. Ankle brachial index screening may be necessary to diagnose unrec ognized PAD in a GIM practice.