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Prevalence of Peripheral Arterial Disease – Results of the Heinz Nixdorf Recall Study

  • Cardiovascular Diseases
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Abstract

Background: This report presents population-based estimates of the prevalence of peripheral arterial disease (PAD), chronic critical limb ischemia (CLI), and Moenckeberg’s medial calcinosis (MC) in Germany. Patients and methods: From the year 2000 to 2003, a total of 4,814 subjects aged 45–75 years were included in the study. In 30 of the subjects (0.6%), determination of the ankle brachial index (ABI) was not possible, leaving 4,735 subjects (99.4%) in the data set. PAD was considered present in all subjects with an ABI < 0.9 in one leg, and/or a history of prior treatment for PAD. CLI was considered present if the highest ankle artery pressure measured < 70 mmHg. Prevalence of MC was calculated for ABI cut-off values of 1.3 and 1.5. Findings: The overall prevalence of PAD according to the ABI criteria was 6.4% among men and 5.1% among women. After accounting for history of PAD, the prevalence increased to 8.2% among men and 5.5% among women. Taking the ABI criteria and medical history into account, males had a higher prevalence of PAD, with large increases in males aged 65–69 and 70–75 years. Chronic CLI was rare in the investigated population, and was found in only five older subjects (0.1%). With the criterion of ABI > 1.3, about 13.3% of males and 6.9% of females had MC. In contrast to PAD, the prevalence of MC did not increase with age. With the criterion of ABI > 1.5, MC was present in only 1.1% and 0.5% of men and women, respectively, but only 30 (0.6%) subjects had incompressible ankle arteries with a cuff pressure > 260 mmHg. Conclusion: Prevalences of PAD based only on ABI generally underestimate the true prevalence of PAD in population-based studies. CLI predominantly affects older subjects. In addition, cut-off values for MC must be newly determined.

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References

  1. WS Aronow (1992) ArticleTitlePrevalence of atherothrombotic brain infarction, coronary artery disease and peripheral arterial disease in elderly Blacks, Hispanics and Whites Am J Cardiol 70 1212–1213 Occurrence Handle10.1016/0002-9149(92)90059-8 Occurrence Handle1:STN:280:DyaK3s%2FjsFSjtQ%3D%3D Occurrence Handle1414949

    Article  CAS  PubMed  Google Scholar 

  2. InstitutionalAuthorNameCAPRIE Steering Committee (1996) ArticleTitleA randomised, blind trial of clopidogrel versus aspirin in patients at risk of ischemic events (CAPRIE) Lancet 348 1329–1339 Occurrence Handle10.1016/S0140-6736(96)09457-3

    Article  Google Scholar 

  3. JD Hooi AD Kester HE Stoffers PE Rinkens JA Knottnerus JW Ree Particlevan (2004) ArticleTitleAsymptomatic peripheral arterial occlusive disease predicted cardiovascular morbidity and mortality in a 7-year follow-up study J Clin Epidemiol 57 294–300 Occurrence Handle10.1016/j.jclinepi.2003.09.003 Occurrence Handle1:STN:280:DC%2BD2c7nt1yqtw%3D%3D Occurrence Handle15066690

    Article  CAS  PubMed  Google Scholar 

  4. K Ouriel (2001) ArticleTitlePeripheral arterial disease Lancet 358 1257–1264 Occurrence Handle10.1016/S0140-6736(01)06351-6 Occurrence Handle1:STN:280:DC%2BD3Mrmsl2nsg%3D%3D Occurrence Handle11675083

    Article  CAS  PubMed  Google Scholar 

  5. J Dormandy L Heeck S Vig (1999) ArticleTitleThe natural history of claudication: Risk to life and limb Semin Vasc Surg 12 123–137 Occurrence Handle1:STN:280:DC%2BD3c3jslSiug%3D%3D Occurrence Handle10777239

    CAS  PubMed  Google Scholar 

  6. WT Meijer AW Hoes D Rutgers ML Bots A Hofman DE Grobbee (1998) ArticleTitlePeripheral arterial disease in the elderly Arterioscler Thromb Vasc Biol 18 185–192 Occurrence Handle1:STN:280:DyaK1c7ktlGisQ%3D%3D Occurrence Handle9484982

    CAS  PubMed  Google Scholar 

  7. AB Newman DS Siscovick TA Manolio et al. (1993) ArticleTitleAnkle-Arm Index as a marker of arteriosclerosis in the Cardiovascular Health Study Circulation 88 837–845 Occurrence Handle1:STN:280:DyaK3szlvVCnsA%3D%3D Occurrence Handle8353913

    CAS  PubMed  Google Scholar 

  8. MH Criqui A Fronek MR Klauber E Barrett-Connor S Gabriel (1985) ArticleTitleThe sensitivity, specificity, and predictive value of traditional clinical evaluation of peripheral arterial disease: Results from non-invasive testing in a defined population Circulation 71 516–522 Occurrence Handle1:STN:280:DyaL2M7isFagsg%3D%3D Occurrence Handle3156007

    CAS  PubMed  Google Scholar 

  9. FGR Fowkes E Housley EHH Cawood CCA Macintyre CV Ruckley RJ Prescott (1991) ArticleTitleEdinburgh Artery Study. Prevalence of asymptomatic and symptomatic peripheral arterial disease in the general population Int J Epidemiol 20 384–392 Occurrence Handle1:STN:280:DyaK38%2FhtVCksw%3D%3D Occurrence Handle1917239

    CAS  PubMed  Google Scholar 

  10. InstitutionalAuthorNameTransAtlantic Inter-Society Working Group (2000) ArticleTitleManagement of peripheral arterial disease J Vasc Surg 31 168–169 Occurrence Handle10.1016/S0741-5214(00)81028-9

    Article  Google Scholar 

  11. J Dormandy L Heeck S Vig (1999) ArticleTitleThe fate of patients with critical leg ischemia Semin Vasc Surg 12 142–147 Occurrence Handle1:STN:280:DC%2BD3c3jslShsg%3D%3D Occurrence Handle10777241

    CAS  PubMed  Google Scholar 

  12. F Binaghi PF Fronteddu F Cannas et al. (1994) ArticleTitlePrevalence of peripheral arterial occlusive disease and associated risk factors in a sample of Southern Sardinian population Int Angiol 13 233–245 Occurrence Handle1:STN:280:DyaK2M7itlWqug%3D%3D Occurrence Handle7822900

    CAS  PubMed  Google Scholar 

  13. J Dormandy L Heeck S Vig (1999) ArticleTitlePredicting which patients will develop chronic critical leg ischemia Semin Vasc Surg 12 138–141 Occurrence Handle1:STN:280:DC%2BD3c3jslSiuw%3D%3D Occurrence Handle10777240

    CAS  PubMed  Google Scholar 

  14. AS Lachman TL Spray DM Kerwin GI Shugoll WC Roberts (1977) ArticleTitleMedial calcinosis of Monckeberg. A review of the problem and a description of a patient with involvement of peripheral, visceral and coronary arteries Am J Med 63 615–622 Occurrence Handle10.1016/0002-9343(77)90207-8 Occurrence Handle1:STN:280:DyaE1c%2FhslCktA%3D%3D Occurrence Handle910809

    Article  CAS  PubMed  Google Scholar 

  15. CM Shanahan NR Cary JR Salisbury D Proudfoot PL Weissberg ME Edmonds (1999) ArticleTitleMedial localization of mineralization-regulating proteins in association with Monckeberg’s sclerosis: Evidence for smooth muscle cell-mediated vascular calcification Circulation 100 2168–2176 Occurrence Handle1:CAS:528:DyaK1MXotFajtr8%3D Occurrence Handle10571976

    CAS  PubMed  Google Scholar 

  16. Y Leskinen JP Salenius T Lehtimaki H Huhtala H Saha (2002) ArticleTitleThe prevalence of peripheral arterial disease and medial arterial calcification in patients with chronic renal failure: Requirements for diagnostics Am J Kidney Dis 40 472–479 Occurrence Handle10.1053/ajkd.2002.34885 Occurrence Handle12200797

    Article  PubMed  Google Scholar 

  17. K Ono A Tsuchida H Kawai et al. (2003) ArticleTitleAnkle-brachial blood pressure index predicts all-cause and cardiovascular mortality in hemodialysis patients J Am Soc Nephrol 14 1591–1598 Occurrence Handle10.1097/01.ASN.0000065547.98258.3D Occurrence Handle12761260

    Article  PubMed  Google Scholar 

  18. Schmermund A, Möhlenkamp S, Stang A, et al. Assessment of clinically silent atherosclerotic disease and established and novel risk factors for predicting myocardial infarction and cardiac death in healthy middle-aged subjects: Rationale and design of the Heinz Nixdorf Recall Study. Am Heart J 2002; 144: 212–218

    Google Scholar 

  19. A Stang W Ahrens KH Jöckel (1999) ArticleTitleControl response proportions in population-based case-control studies in Germany Epidemiology 10 181–183 Occurrence Handle10.1097/00001648-199903000-00014 Occurrence Handle1:STN:280:DyaK1M7ms1OrtA%3D%3D Occurrence Handle10069256

    Article  CAS  PubMed  Google Scholar 

  20. A Stang S Moebus N Dragano et al. (2005) ArticleTitleBaseline recruitment and analyses of nonresponse of the Heinz Nixdorf Study: Identifiability of phone numbers as the major determinant of response Eur J Epidemiol 20 489–496 Occurrence Handle10.1007/s10654-005-5529-z Occurrence Handle1:STN:280:DC%2BD2MvlsVOksA%3D%3D Occurrence Handle16121757

    Article  CAS  PubMed  Google Scholar 

  21. M Hirschl M Francesconi MM Hirschl (1991) ArticleTitleMoenckeberg media sclerosis: Clinical aspects in diabetic patients Vasa 20 216–221 Occurrence Handle1:STN:280:DyaK38%2FlslWmsw%3D%3D Occurrence Handle1950137

    CAS  PubMed  Google Scholar 

  22. TC Collins NJ Petersen M Suarez-Almazor CM Ashton (2003) ArticleTitleThe prevalence of peripheral arterial disease in a racially diverse population Arch Intern Med 163 1469–1474 Occurrence Handle10.1001/archinte.163.12.1469 Occurrence Handle12824097

    Article  PubMed  Google Scholar 

  23. HE Resnick RS Lindsay MM McDermott et al. (2004) ArticleTitleRelationship of high and low ankle brachial index to all-cause and cardiovascular disease mortality: The Strong Heart Study Circulation 109 733–739 Occurrence Handle10.1161/01.CIR.0000112642.63927.54 Occurrence Handle14970108

    Article  PubMed  Google Scholar 

  24. SAS Institute Inc.1990 SAS/STAT User’s Guide, Version 8. SAS Institute, Inc.: Cary, NC. 1990

  25. E Selvin TP Erlinger (2004) ArticleTitlePrevalence of and risk factors for peripheral arterial disease in the United States: Results from the National Health and Nutrition Examination Survey, 1999–2000 Circulation 110 738–743 Occurrence Handle10.1161/01.CIR.0000137913.26087.F0 Occurrence Handle15262830

    Article  PubMed  Google Scholar 

  26. EW Gregg P Sorlie R Paulose-Ram et al. (2004) ArticleTitlePrevalence of lower-extremity disease in the US adult population ≥40 years of age with and without diabetes: 1999–2000 national health and nutrition examination survey Diabetes Care 27 1591–1597 Occurrence Handle15220233

    PubMed  Google Scholar 

  27. JP Higgins JA Higgins (2003) ArticleTitleEpidemiology of peripheral arterial disease in women J Epidemiol 13 1–14 Occurrence Handle12587608

    PubMed  Google Scholar 

  28. AB Newman BL Naydeck K Sutton-Tyrrell JF Polak LH Kuller (2001) ArticleTitleCardiovascular Health Study Research Group. The role of comorbidity in the assessment of intermittent claudication in older adults J Clin Epidemiol 54 294–300 Occurrence Handle10.1016/S0895-4356(00)00308-5 Occurrence Handle1:STN:280:DC%2BD3M7lt1enug%3D%3D Occurrence Handle11223327

    Article  CAS  PubMed  Google Scholar 

  29. WR Hiatt S Hoag RF Hamman (1995) ArticleTitleEffect of diagnostic criteria on the prevalence of peripheral arterial disease. The San Luis Valley Diabetes Study Circulation 91 1472–1479 Occurrence Handle1:STN:280:DyaK2M7ntFGrsA%3D%3D Occurrence Handle7867189

    CAS  PubMed  Google Scholar 

  30. HEJH Stoffers PELM Rinkens ADM Kester V Kaiser JA Knottnerus (1996) ArticleTitleThe prevalence of asymptomatic and unrecognized peripheral arterial occlusive disease Int J Epidemiol 25 282–290 Occurrence Handle1:STN:280:DyaK2s%2FhsVGhsw%3D%3D Occurrence Handle9119553

    CAS  PubMed  Google Scholar 

  31. MT Vogt JA Cauley LH Kuller SB Hulley (1993) ArticleTitlePrevalence and correlates of lower extremity arterial disease in elderly women Am J Epidemiol 137 559–568 Occurrence Handle1:STN:280:DyaK3s3itVKltw%3D%3D Occurrence Handle8465807

    CAS  PubMed  Google Scholar 

  32. JM Murabito RBD D’Agostino H Silberhatz PWF Wilson (1997) ArticleTitleIntermittent claudication Circulation 96 44–49 Occurrence Handle1:STN:280:DyaK2sznvFKitA%3D%3D Occurrence Handle9236415

    CAS  PubMed  Google Scholar 

  33. MM McDermott K Liu P Greenland et al. (2004) ArticleTitleFunctional decline in peripheral arterial disease: Associations with the ankle brachial index and leg symptoms JAMA 292 453–461 Occurrence Handle10.1001/jama.292.4.453 Occurrence Handle1:CAS:528:DC%2BD2cXmtFOms74%3D Occurrence Handle15280343

    Article  CAS  PubMed  Google Scholar 

  34. AM OHare DV Glidden CS Fox CY Hsu (2004) ArticleTitleHigh prevalence of peripheral arterial disease in persons with renal insufficiency: Results from the national health and nutrition examination survey 1999–2000 Circulation 109 320–323 Occurrence Handle10.1161/01.CIR.0000114519.75433.DD

    Article  Google Scholar 

  35. InstitutionalAuthorNameThe Vascular Surgical Society of Great Britain, Ireland (1995) ArticleTitleCritical limb ischaemia: Management and outcome. Report of a National Survey Eur J Vasc Endovasc Surg 10 108–113 Occurrence Handle10.1016/S1078-5884(05)80206-0

    Article  Google Scholar 

  36. FG Quigley IB Faris HJ Duncan (1991) ArticleTitleA comparison of Doppler ankle pressures and skin perfusion pressure in subjects with and without diabetes Clin Physiol 11 21–25 Occurrence Handle1:STN:280:DyaK3M3gvVyktA%3D%3D Occurrence Handle2019075

    CAS  PubMed  Google Scholar 

  37. U Latza A Stang M Bergmann et al. (2004) ArticleTitleThe problem of response in epidemiological studies in Germany (part I) Gesundheitswesen 66 326–336 Occurrence Handle10.1055/s-2004-813093 Occurrence Handle1:STN:280:DC%2BD2c3ktF2lsQ%3D%3D Occurrence Handle15141353

    Article  CAS  PubMed  Google Scholar 

  38. A Stang KH Jöckel (2004) ArticleTitleLow response rate studies may be less biased than high response rate studies Am J Epidemiol 159 204–210 Occurrence Handle10.1093/aje/kwh009 Occurrence Handle14718223

    Article  PubMed  Google Scholar 

  39. A Stang (2003) ArticleTitleNonresponse research – an underdeveloped field in epidemiology (editorial) Eur J Epidemiol 18 929–931 Occurrence Handle10.1023/A:1025877501423 Occurrence Handle14598921

    Article  PubMed  Google Scholar 

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Kröger, K., Stang, A., Kondratieva, J. et al. Prevalence of Peripheral Arterial Disease – Results of the Heinz Nixdorf Recall Study. Eur J Epidemiol 21, 279–285 (2006). https://doi.org/10.1007/s10654-006-0015-9

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