Peripheral Arterial Disease in the Elderly

The Rotterdam Study

From the Department of Epidemiology and Biostatistics (W.T.M., A.W.H., D.R., M.L.B., A.H., D.E.G.) and the Department of General Practice (W.T.M., D.R.), Erasmus University Medical School, Rotterdam; and the Department of General Practice (A.W.H.), and Julius Center for Patient Oriented Research (A.W.H., M.L.B., D.E.G.), Utrecht University, Utrecht, the Netherlands.

Correspondence to Dr Diederick E. Grobbee, Professor of Clinical Epidemiology, Julius Center for Patient Oriented Research, Utrecht University Medical School, Universiteitsweg 100, PO Box 80035, 3508 TA Utrecht, the Netherlands. E-mail d.e.grobbee{at}med.ruu.nl

Abstract—To assess the age- and sex-specific prevalence of peripheral arterial disease (PAD) and intermittent claudication (IC) in an elderly population, we performed a population-based study in 7715 subjects (40% men, 60% women) aged 55 years and over. The presence of PAD and IC was determined by measuring the ankle-arm systolic blood pressure index (AAI) and by means of the World Health Organization/Rose questionnaire, respectively. PAD was considered present when the AAI was <0.90 in either leg. The prevalence of PAD was 19.1% (95% confidence interval, 18.1% to 20.0%): 16.9% in men and 20.5% in women. Symptoms of IC were reported by 1.6% (95% confidence interval, 1.3% to 1.9%) of the study population (2.2% in men, 1.2% in women). Of those with PAD, 6.3% reported symptoms of IC (8.7% in men, 4.9% in women), whereas in 68.9% of those with IC an AAI below 0.90 was found. Subjects with an AAI <0.90 were more likely to be smokers, to have hypertension, and to have symptomatic or asymptomatic cardiovascular disease compared with subjects with an AAI of 0.90 or higher. The authors conclude that the prevalence of PAD in the elderly is high whereas the prevalence of IC is rather low, although both prevalences clearly increase with advancing age. The vast majority of PAD patients reports no symptoms of IC.

Key Words: atherosclerosis • elderly • intermittent claudication • peripheral arterial disease • cardiovascular risk

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				R. Vliegenthart, J. M. Geleijnse, A. Hofman, W. T. Meijer, F. J. A. van Rooij, D. E. Grobbee, and J. C. M. Witteman Alcohol Consumption and Risk of Peripheral Arterial Disease : The Rotterdam Study Am. J. Epidemiol., February 15, 2002; 155(4): 332 - 338. [Abstract] [Full Text] [PDF]

				H. Gaylis, L. S. Geiss, E. Gregg, M. M. Engelgau, R. P. Ram, M. S. Eberhardt, V. L. Burt, J. H. Merenstein, M. Jimbo, R. E. Fried, et al. Diagnosis and Treatment of Peripheral Arterial Disease JAMA, January 16, 2002; 287(3): 313 - 316. [Full Text] [PDF]

				A. T. Hirsch, M. H. Criqui, D. Treat-Jacobson, J. G. Regensteiner, M. A. Creager, J. W. Olin, S. H. Krook, D. B. Hunninghake, A. J. Comerota, M. E. Walsh, et al. Peripheral Arterial Disease Detection, Awareness, and Treatment in Primary Care JAMA, September 19, 2001; 286(11): 1317 - 1324. [Abstract] [Full Text] [PDF]

				A. E. Hak, H. A. P. Pols, C. D. A. Stehouwer, J. Meijer, A. J. Kiliaan, A. Hofman, M. M. B. Breteler, and J. C. M. Witteman Markers of Inflammation and Cellular Adhesion Molecules in Relation to Insulin Resistance in Nondiabetic Elderly: The Rotterdam Study J. Clin. Endocrinol. Metab., September 1, 2001; 86(9): 4398 - 4405. [Abstract] [Full Text] [PDF]

				W. R. Hiatt Medical Treatment of Peripheral Arterial Disease and Claudication N. Engl. J. Med., May 24, 2001; 344(21): 1608 - 1621. [Full Text] [PDF]

				A. B. Newman, J. S. Gottdiener, M. A. McBurnie, C. H. Hirsch, W. J. Kop, R. Tracy, J. D. Walston, and L. P. Fried Associations of Subclinical Cardiovascular Disease With Frailty J. Gerontol. A Biol. Sci. Med. Sci., March 1, 2001; 56(3): 158M - 166. [Abstract] [Full Text]

				M. H Criqui Peripheral arterial disease - epidemiological aspects Vascular Medicine, February 1, 2001; 6(1_suppl): 3 - 7. [Abstract] [PDF]

				J. Schweizer, W. Kirch, R. Koch, A. Muller, G. Hellner, and L. Forkmann Short- and Long-Term Results of Abciximab Versus Aspirin in Conjunction with Thrombolysis for Patients with Peripheral Occlusive Arterial Disease and Arterial Thrombosis Angiology, November 1, 2000; 51(11): 913 - 923. [Abstract] [PDF]

				W. T. Meijer, D. E. Grobbee, M. G. M. Hunink, A. Hofman, and A. W. Hoes Determinants of Peripheral Arterial Disease in the Elderly: The Rotterdam Study Arch Intern Med, October 23, 2000; 160(19): 2934 - 2938. [Abstract] [Full Text] [PDF]

				I. C. D. Westendorp, B. A. in't Veld, D. E. Grobbee, H. A. P. Pols, W. T. Meijer, A. Hofman, and J. C. M. Witteman Hormone Replacement Therapy and Peripheral Arterial Disease: The Rotterdam Study Arch Intern Med, September 11, 2000; 160(16): 2498 - 2502. [Abstract] [Full Text]

				L. Papoz, A. Ponton, P. Segond, F. Becker, L. Drouet, J. Levenson, M. Marazanof, Y. Sentou, E. Chollet, J. Etiemble, et al. Feasibility and Reliability of Ankle/Arm Blood Pressure Index in Preventive Medicine Angiology, June 1, 2000; 51(6): 463 - 471. [Abstract] [PDF]