Circulation, Vol 72, 768-773, Copyright © 1985 by American Heart Association
MH Criqui, SS Coughlin and A Fronek
Intermittent claudication has been reported in previous studies to
approximately double the risk of subsequent mortality. However, a history
of claudication is often present in the absence of significant peripheral
arterial disease (PAD) and absent in the presence of PAD. For this reason
we evaluated the association between large-vessel and small-vessel PAD,
measured by highly reliable and valid noninvasive tests, and mortality in
567 older subjects from a defined population followed-up for an average of
4 years. Large-vessel PAD was strongly and significantly predictive of
all-cause mortality in both men and women with a relative risk of 4 to 5,
and this finding was independent of other cardiovascular disease risk
factors in multivariable analysis. In addition, this finding persisted
after exclusion of subjects with extant cardiovascular disease at baseline.
The associations of both claudication and abnormal peripheral pulses with
mortality were weaker than the large-vessel PAD association. Isolated
small-vessel PAD was unrelated to subsequent mortality. These findings
suggest older subjects of both sexes at a high risk of impending mortality
can be identified through noninvasive testing for large-vessel PAD.
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