Randomized controlled trial of supervised exercise to evaluate changes in cardiac function in patients with peripheral atherosclerotic disease Ten Year Mortality in Different Peripheral Arterial Disease Stages: A Population Based Observational Study on Outcome. Prognostic value of functional performance for mortality in patients with peripheral artery disease. Mortality and Vascular Morbidity in Older Adults With Asymptomatic Versus Symptomatic Peripheral Artery Disease Unsupervised Exercise and Mobility Loss in Peripheral Artery Disease: A Randomized Controlled Trial Peripheral Arterial Disease as an Independent Predictor for Excess Stroke Morbidity and Mortality in Primary-Care Patients: 5-Year Results of the getABI Study Microalbuminuria and peripheral arterial disease are independent predictors of cardiovascular and all-cause mortality, especially among hypertensive subjects: five-year follow-up of the Hoorn Study. Presentations of major peripheral arterial disease and risk of major outcomes in patients with type 2 diabetes: results from the ADVANCE-ON study Using ankle-brachial index to detect peripheral arterial disease: prevalence and associated risk factors in a random population sample. Recruitment to clinical trials of exercise: challenges in the peripheral arterial disease population. A group-mediated, home-based physical activity intervention for patients with peripheral artery disease: effects on social and psychological function Prevalence of Peripheral Arterial Disease and Related Risk Factors in an Urban Mexican Population Distribution of ankle—brachial index and the risk factors of peripheral artery disease in a multi-ethnic Asian population Screening of unrecognized peripheral arterial disease (PAD) using ankle-brachial index in high cardiovascular risk patients free from symptomatic PAD. A population-based study of peripheral arterial disease prevalence with special focus on critical limb ischemia and sex differences. High prevalence of peripheral arterial disease in hypertensive patients: the Evaluation of Ankle-Brachial Index in Hungarian Hypertensives screening program Ankle-brachial index and the incidence of cardiovascular events in the Mediterranean low cardiovascular risk population ARTPER cohort
Introduction : Peripheral atherosclerotic disease ( PAD ) is a condition characterized by low functional capacity which is associated with impaired free living , ambulation and low exercise tolerance . The purpose of this r and omized controlled study was to evaluate whether changes in maximal walking time are associated with adaptations in cardiovascular function following supervised exercise OBJECTIVE The aim was to determine long-term mortality rates and the underlying cause of death for subjects with different peripheral arterial disease ( PAD ) stages in a population based setting . METHODS A r and omly selected population sample of 5080 subjects was enrolled in the study in 2004 - 2005 . Participants completed health state question naires and underwent ankle brachial index ( ABI ) measurements for classification into PAD severity stages and reference subjects . A follow-up was conducted by the end of 2015 using data from Swedish governmental national registers for cause of death , which was then compared with PAD stage determined at baseline in 2005 . RESULTS The 10 year all cause mortality was 27 % for reference cases , 56 % for asymptomatic PAD ( APAD ) , 63 % for intermittent claudication ( IC ) , and 75 % for severe limb ischaemia ( SLI ) . Among all PAD subjects , cardiovascular ( CV ) causes were the most common main cause of death ( 45 % ) and a CV event was present as either the main or one of the three most common contributing causes of death in 64 % of the cases . The age adjusted hazard ratios for a main cause of death by a CV event were 1.9 ( 95 % CI 1.5 - 2.3 ) for APAD , 2.6 ( 95 % CI 2.1 - 3.4 ) for IC , and 3.5 ( 95 % CI 2.3 - 5.2 ) for SLI . CONCLUSION PAD subjects , including the APAD subjects , are still at high risk of CV death . The mortality risks are more than doubled in symptomatic PAD patients compared with reference subjects and increase by severity of PAD stage . Awareness and improved risk reduction management of PAD are still warranted OBJECTIVES Among persons with lower extremity peripheral artery disease ( PAD ) , we determined whether objective measures of walking performance predict mortality independently of the ankle brachial index ( ABI ) . BACKGROUND The ability of office-based functional performance measures to predict mortality in patients with PAD is unknown . METHODS Participants were 444 persons with PAD followed prospect ively for 4.8 years . The 6-min walk and 4-m walks at usual and fastest pace were measured at baseline . Cox proportional hazard models were used to assess relations between baseline measures of lower extremity performance with mortality , adjusting for confounders . RESULTS One hundred twenty-seven patients ( 28.6 % ) died during follow-up . Adjusting for age , gender , race , comorbidities , ABI , and other confounders , participants in the poorest baseline quartile of 6-min walk performance had significantly increased total mortality ( hazard ratio [ HR ] 2.36 [ 95 % confidence interval ( CI ) 1.33 to 4.18 ] ) and cardiovascular mortality ( HR 5.59 [ 95 % CI 1.97 to 15.9 ] ) compared with the best quartile of baseline performance . Participants in the poorest baseline quartile of normal-paced 4-m walking speed had significantly increased total mortality ( HR 1.86 [ 95 % CI 1.06 to 3.29 ] ) and cardiovascular mortality ( HR 2.55 [ 95 % CI 1.01 to 6.46 ] ) compared with the best quartile of baseline performance . CONCLUSIONS This study demonstrates for the first time that performance-based measures , which can be administered in an office setting , provide prognostic information regarding mortality in persons with PAD beyond that provided by the ABI Background — Our aim was to assess the mortality and vascular morbidity risk of elderly individuals with asymptomatic versus symptomatic peripheral artery disease ( PAD ) in the primary care setting . Methods and Results — This prospect i ve cohort study included 6880 representative unselected patients ≥65 years of age with monitored follow-up over 5 years . According to physician diagnosis , 5392 patients had no PAD , 836 had asymptomatic PAD ( ankle brachial index < 0.9 without symptoms ) , and 593 had symptomatic PAD ( lower-extremity peripheral revascularization , amputation as  a  result  of PAD , or intermittent claudication symptoms regardless of ankle brachial index ) . The risk of symptomatic compared with asymptomatic PAD patients was significantly increased for the composite of all-cause death or severe vascular event ( myocardial infa rct ion , coronary revascularization , stroke , carotid revascularization , or lower-extremity peripheral vascular events ; hazard ratio , 1.48 ; 95 % confidence interval , 1.21 to 1.80 ) but not for all-cause death alone ( hazard ratio , 1.13 ; 95 % confidence interval , 0.89 to 1.43 ) , all-cause death/myocardial infa rct ion/stroke ( excluding lower-extremity peripheral vascular events and any revascularizations ; hazard ratio , 1.18 ; 95 % confidence interval , 0.92 to 1.52 ) , cardiovascular events alone ( hazard ratio , 1.20 ; 95 % confidence interval , 0.89 to 1.60 ) , or cerebrovascular events alone ( hazard ratio , 1.33 ; 95 % confidence interval , 0.80 to 2.20 ) . Lower ankle brachial index categories were associated with increased risk . PAD was a strong factor for the prediction of the composite end point in an adjusted model . Conclusions — Asymptomatic PAD diagnosed through routine screening in the offices of primary care physicians carries a high mortality and /or vascular event risk . Notably , the risk of mortality was similar in symptomatic and asymptomatic patients with PAD and was significantly higher than in those without PAD . In the primary care setting , the diagnosis of PAD has important prognostic value Background Few medical therapies improve lower extremity functioning in people with lower extremity peripheral artery disease ( PAD ) . Among people with PAD , we studied whether a group-mediated cognitive behavioral intervention promoting home-based unsupervised exercise prevented mobility loss and improved functional performance compared to control . Methods and Results One hundred ninety-four PAD participants were r and omized . During months 1 to 6 , the intervention group met weekly with other PAD participants and a facilitator . Group support and self-regulatory skills were used to help participants adhere to walking exercise . Ninety-percent of exercise was conducted at or near home . The control group attended weekly lectures . During months 6 to 12 , each group received telephone contact only . Primary outcomes have been reported . Here we compare changes in exploratory outcomes of mobility loss ( the inability to climb a flight of stairs or walk one-quarter mile without assistance ) , walking velocity , and the Short Physical Performance Battery . Compared to controls , fewer participants r and omized to the intervention experienced mobility loss at 6-month follow-up : 6.3 % versus 26.5 % , P=0.002 , odds ratio=0.19 ( 95 % CI=0.06 to 0.58 ) and at 12-month follow-up : 5.2 % versus 18.5 % , P=0.029 , odds ratio=0.24 ( 95 % CI=0.06 to 0.97 ) . The intervention improved fast-paced 4-m walking velocity at 6-month follow-up ( P=0.005 ) and the Short Physical Performance Battery at 12-month follow-up ( P=0.027 ) , compared to controls . Conclusions In exploratory analyses , a group-mediated cognitive behavioral intervention promoting unsupervised walking exercise prevented mobility loss and improved functioning at 6- and 12-month follow-up in PAD patients . Clinical Trial Registration URL : http:// clinical trials.gov . Unique identifier : NCT00693940 Background : There is controversial evidence with regard to the significance of peripheral arterial disease ( PAD ) as an indicator for future stroke risk . We aim ed to quantify the risk increase for mortality and morbidity associated with PAD . Methods : In an open , prospect i ve , noninterventional cohort study in the primary care setting , a total of 6,880 unselected patients ≧65 years were categorized according to the presence or absence of PAD and followed up for vascular events or deaths over 5 years . PAD was defined as ankle-brachial index ( ABI ) < 0.9 or history of previous peripheral revascularization and /or limb amputation and /or intermittent claudication . Associations between known cardiovascular risk factors including PAD and cerebrovascular mortality/events were analyzed in a multivariate Cox regression model . Results : During the 5-year follow-up [ 29,915 patient-years ( PY ) ] , 183 patients had  a stroke ( incidence per 1,000 PY : 6.1 cases ) . In  patients with PAD  ( n = 1,429 ) compared to those without PAD ( n = 5,392 ) , the incidence of all stroke types st and ardized per 1,000 PY , with the exception of hemorrhagic stroke , was about doubled ( for fatal stroke tripled ) . The corresponding adjusted hazard ratios were 1.6 ( 95 % confidence interval , CI , 1.1–2.2 ) for total stroke , 1.7 ( 95 % CI 1.2–2.5 ) for ischemic stroke , 0.7 ( 95 % CI 0.2–2.2 ) for hemorrhagic stroke , 2.5 ( 95 % CI 1.2–5.2 ) for fatal stroke and 1.4 ( 95 % CI 0.9–2.1 ) for nonfatal stroke . Lower ABI categories were associated with higher stroke rates . Besides high age , previous stroke and diabetes mellitus , PAD was a significant independent predictor for ischemic stroke . Conclusions : The risk of stroke is substantially increased in PAD patients , and PAD is a strong independent predictor for stroke Microalbuminuria ( MA ) is associated with increased  cardiovascular and all-cause mortality .  It has been proposed that MA reflects generalized atherosclerosis and may thus predict mortality . To investigate this hypothesis , we studied the associations between , on the one h and , MA and peripheral arterial disease ( PAD ) , a generally accepted marker of generalized atherosclerosis , and , on the other h and , cardiovascular and all-cause mortality in an age- , sex- , and glucose tolerance-stratified sample ( n=631 ) of a population -based cohort aged 50 to 75 years followed prospect ively for 5 years . At baseline , the  albumin-to-creatinine ratio ( ACR ) was measured in an overnight spot urine sample ; MA was defined as ACR > 2.0 mg/mmol . PAD was defined as an ankle-brachial pressure index below 0.90 and /or a history of a peripheral arterial bypass or amputation . After 5 years of follow-up , 58 subjects had died ( 24 of cardiovascular causes ) . Both MA and PAD were associated with a 4-fold increase in cardiovascular mortality . After adjusting for age , sex , diabetes mellitus , hypertension , levels of total and HDL-cholesterol and triglyceride , body mass index , smoking habits , and preexistent ischemic heart disease , the relative risks ( RR ) ( 95 % confidence intervals ) were 3.2 ( 1.3 to 8.1 ) for MA and 2.4 ( 0.9 to 6.1 ) for PAD . When both MA and PAD were included in the multivariate analysis , the RRs were 2.9 ( 1.1 to 7.3 ) for MA and 2.0 ( 0.7 to 5.7 ) for PAD . MA and PAD were both associated with an about 2-fold increase in all-cause mortality . The RRs of all-cause mortality associated with MA and PAD were about 4 times higher among hypertensive than among normotensive subjects . We conclude that both MA and PAD are associated with an increased risk of cardiovascular mortality . MA and PAD are mutually independent risk indicators . The associations of MA and PAD with all-cause mortality are somewhat weaker . They are more pronounced in the presence of hypertension than in its absence . These data suggest that MA affects mortality risk through a mechanism different from generalized atherosclerosis Background Peripheral arterial disease ( PAD ) is known to be associated with high cardiovascular risk , but the individual impact of PAD presentations on risk of macrovascular and microvascular events has not been reliably compared in patients with type 2 diabetes . We aim ed to evaluate the impact of major PAD , and its different presentations , on the 10-year risk of death , major macrovascular events , and major clinical microvascular events in these patients . Methods Participants in the action in diabetes and vascular disease :  PreterAx and DiamicroN modified-release controlled evaluation ( ADVANCE ) trial and the ADVANCE-ON post-trial study were followed for a median of 5.0 ( in-trial ) , 5.4 ( post-trial ) , and 9.9 ( overall ) years . Major PAD at baseline was subdivided into lower-extremity chronic ulceration or amputation secondary to vascular disease and history of peripheral revascularization by angioplasty or surgery . Results Among 11,140 participants , 516 ( 4.6 % ) had major PAD at baseline : 300 ( 2.7 % ) had  lower-extremity  ulceration or amputation alone , 190 ( 1.7 % ) had peripheral revascularization alone , and 26 ( 0.2 % ) had both presentations . All-cause mortality , major macrovascular events , and major clinical microvascular events occurred in 2265 ( 20.3 % ) , 2166 ( 19.4 % ) , and 807 ( 7.2 % ) participants , respectively . Compared to those without PAD , patients with major PAD had increased rates of all-cause mortality ( HR 1.35 , 95 % CI 1.15–1.60 , p = 0.0004 ) , and major macrovascular events ( 1.47 [ 1.23–1.75 ] , p < 0.0001 ) , after multiple adjustments for region of origin , cardiovascular risk factors and treatments , peripheral neuropathy markers , and r and omized treatments . We have also observed a trend toward an association of baseline PAD with risk of major clinical microvascular events [ 1.31 ( 0.96–1.78 ) , p = 0.09 ] . These associations were comparable for patients with a lower-extremity ulceration or amputation and for those with a history of peripheral revascularization . Furthermore , the risk of retinal photocoagulation or blindness , but not renal events , increased in patients with lower-extremity ulceration or amputation [ 1.53 ( 1.01–2.30 ) , p = 0.04 ] . Conclusions Lower-extremity ulceration or amputation , and peripheral revascularization both increased the risks of death and cardiovascular events , but only lower-extremity ulceration or amputation increased the risk of severe retinopathy in patients with type 2 diabetes .  Screening for major PAD and its management remain crucial for cardiovascular prevention in patients with type 2 diabetes ( Clinical Trials.gov number , NCT00949286 ) BACKGROUND AND AIM The ankle-brachial index ( ABI ) is being used increasingly to diagnose peripheral arterial disease ( PAD ) that predicts cardiovascular morbidity and mortality . The aim of this study is to determine the prevalence of PAD  and associated risk factors in a Spanish r and om population sample of age > or = 40 . METHODS AND RESULTS PAD is defined as an ABI<0.9 in either leg . 784 participants of age > or = 40 were r and omly selected in a Spanish province . 55.4 % of them were female . The prevalence of PAD in this sample was 10.5 % ( 95 % confidence interval ( CI ) 8.4 - 12.8 ) ; 9.7 % in females and 11.4 % in males . In logistic regression analyses , adjusted for age and gender , smoking per 10 pack-years ( odds ratio ( OR ) 1.40 , 95 % CI 1.23 - 1.58 ) , hypertension ( OR 1.85 , 95 % CI 1.05 - 3.28 ) , hypercholesterolemia ( OR 1.76 , 95 % CI 1.04 - 2.98 ) , and diabetes ( OR 1.80 , 95 % CI 1.04 - 3.11 ) were positively associated with prevalent PAD . More than 91 % of persons with PAD had one or more cardiovascular disease risk factors . CONCLUSIONS We conclude that in our study hypertension , hypercholesterolemia , diabetes mellitus and smoking are associated with PAD . The majority of individuals with PAD had at least one important cardiovascular risk factor advanced enough to be considered eligible for an aggressive treatment OBJECTIVES To describe recruitment to a r and omised controlled trial of a 12-week ( twice-weekly ) supervised exercise programme for patients with peripheral arterial disease ( PAD ) . PAD is a chronic , progressive disease with a significant cardiovascular and cerebrovascular risk burden , and exercise is an effective primary management approach . METHOD Potential patients were identified from the Non-Invasive Vascular Laboratory records and invited to participate in the study . On successful completion of an incremental treadmill exercise test , patients were allocated at r and om to a control ( usual care ) or an exercise group . RESULTS Between November 2006 and June 2009 , 548 patients were identified . Of the 156 patients who met the inclusion criteria , 40 ( 26 % ) declined to participate . Of the 71 patients who underwent exercise testing  , 23 ( 32 % ) did not complete the test . The final enrolment number was 44 ( 44/156 ; 28 % ) . Eleven patients ( 11/28 ; 39 % ) subsequently withdrew from the exercise programme . CONCLUSION Recruitment to clinical trials of exercise presents significant challenges in the PAD population due to the presence of co-existing cardiovascular and cerebrovascular disease , a reluctance to exercise due to leg pain , and an acceptance of reduced mobility as part of ageing . Early identification in primary care before the onset of significant comorbidity may ameliorate some of these issues Background PAD is a disabling , chronic condition of the lower extremities that affects approximately 8 million people in the United States . The purpose of this study was to determine whether an innovative home-based walking exercise program for patients with peripheral artery disease ( PAD ) improves self-efficacy for walking , desire for physical competence , satisfaction for physical functioning , social functioning , and acceptance of PAD related pain and discomfort . Methods The design was a 6-month r and omized controlled clinical trial of 194 patients with PAD . Participants were r and omized to 1 of 2 parallel groups : a home-based group-mediated cognitive behavioral walking intervention or an attention control condition . Results Of the 194 participants r and omized , 178 completed the baseline and 6-month follow-up visit . The mean age was 70.66 ( ±9.44 ) and was equally represented by men and women . Close to half of the cohort was African American . Following 6-months of treatment , the intervention group experienced greater improvement on self-efficacy ( p = .0008 ) , satisfaction with functioning ( p = .0003 ) , pain acceptance ( p = .0002 ) , and social functioning ( p = .0008 ) than the control group ; the effects were consistent across a number of potential moderating variables . Change in these outcomes was essentially independent of change in 6-minute walk performance . Trial registration [ Clinical Trials.gov Identifier : NCT00693940 Peripheral arterial disease ( PAD ) is a growing and often underdiagnosed health problem that predicts cardiovascular events and mortality . Estimating its prevalence in the general popula tion is a major issue for assessing health needs and planning health services . The aim of this study was to determine the prevalence of PAD and its risk factors in an urban Mexican popu lation . A r and om sample of 400 adult subjects was selected from a Family Medical Unit of the Mexican Institute of the Social Security .  Clinical examination was performed and a question naire was applied to all subjects . After an overnight fast , serum glucose , triglyceride , and cholesterol concentrations were measured . Blood pressure was taken and the ankle-brachial index ( ABI ) was calculated by Doppler examination in both sides . PAD was diagnosed if one of the ABIs was less than 0.90 . Prevalence was estimated with 95 % confidence intervals ( CI95 % ) , and odds ratios ( OR ) with CI95 % were obtained to assess association with some atherogenic risk factors in a multiple logistic regression analysis . The prevalence of PAD was 10.0 % ( CI95 % , 7.24%-13.37 % ) , and it was higher in men . Most subjects with PAD had no signs or symptoms , although the presence of either signs or symptoms was more frequent in subjects with PAD . The main risk factors related to PAD were serum triglycerides ≥150 mg/dL ( OR 2.25 ; CI95 % 1.0 - 5.1 ) , heavy smoking ( OR 2.5 ; CI95 % 0.9 - 6.7 ) and a history of diabetes mellitus for longer than 7 years ( OR 1.9 ; CI95 % 0.6 - 5.8 ) . The prevalence of PAD is high in this Mexican urban population . Asymptomatic PAD may be highly frequent , and low-cost , noninvasive Doppler ultrasonography should be considered as an adequate screening procedure in primary care to detect individuals at high risk for major cardiovascular events Peripheral artery disease ( PAD ) is a manifestation of systemic atherosclerosis and is associated with increased cardiovascular morbidity and mortality . We describe the prevalence and risk factors of PAD in a multi-ethnic Asian population ( Chinese , Malays and Indians ) in Singapore . The Singapore Prospect i ve Study Program recruited 4132 individuals between 2004 and 2006 in which the ankle — brachial index ( ABI ) was measured using the  Smartdop ™ 20EX bi-directional blood flow detector . PAD was defined as ≤ 0.9 and a high ABI > 1.4 , with ABI 1.11—1.20 as reference . The mean age ( SD ) of individuals in the study was 49.9 ( 11.8 ) years , with 51.8 % females . PAD was present in 4.3 % of the population and a high ABI ( > 1.4 ) was rare . Malays and Indians had a higher risk ( especially in females ) . Compared to those with an ABI between 1.11 and 1.20 , those with PAD were more likely to be of Malay and Indian ethnicity , female sex , with higher systolic blood pressure and pulse pressure , with increased prevalence of diabetes mellitus , hypertension , albuminuria and renal impairment , and with a past history of stroke . In conclusion , in this large multi-ethnic Asian population , we document the distribution and risk factor associations for PAD . PAD shows an ethnic distribution similar to that of coronary artery disease in Singapore , with differences in sex distribution . Apart from traditional vascular risk factors , pulse pressure , renal impairment and a past history of stroke are important determinants of PAD OBJECTIVE To determine the utility of  ankle-brachial index ( ABI )  in screening for unrecognized peripheral arterial disease ( PAD ) . Although PAD is a consistent predictor of cardiovascular morbidity and mortality , it is often under-diagnosed and under-treated . METHODS In this prospect i ve , observational , real-life , epidemiologic study ( ELLIPSE ) the prevalence of  PAD ( ABI < 0.9 )  was calculated in 2146 asymptomatic patients > or = 55 years of age who were at high cardiovascular risk and who were hospitalized in departments of cardiology , diabetology , geriatrics , internal medicine , or neurology in metropolitan France .  Univariate and multivariate analyses were performed to identify PAD risk factors . The discriminatory power of the model was evaluated by calculating the area under the curve ( AUC ) of the receiver operating characteristic curve . RESULTS The ABI was < 0.9 in 41.1 % of patients . In the multivariate analysis , absence of > or = 1 pulse ( odds ratio [ OR ] , 2.18 ; 95 % confidence interval [ CI ] , 1.81 to 2.63 ; P < .0001 ) , arterial bruit ( OR , 1.92 ; 95%CI , 1.34 to 2.75 ; P < .0004 ) , previous non-Q-wave myocardial infa rct ion ( OR , 1.50 ; 95%CI , 1.08 to 2.08 ; P = .02 ) , regular smoking ( OR , 1.49 ; 95%CI , 1.22 to 1.80 ; P < .0001 ) , age > or = 81 years ( OR , 1.45 ; 95%CI , 1.15 to 1.82 ; P = .001 ) , creatinine clearance < 60 mL/min ( OR , 1.33 ; 95%CI , 1.08 to 1.63 ; P = .008 ) , and treated hypertension ( OR , 1.28 ; 95%CI , 1.03 to 1.59 ; P = .03 ) were significantly associated with PAD . Although risk increased with the number of variables , the model , based on clinical symptoms and on medical history parameters , was not discriminatory ( AUC = 0.66 ) . On average , physicians took 15 minutes to perform the ABI test . CONCLUSIONS The high prevalence of asymptomatic PAD in this patient population suggests that ABI should systematic ally be performed in high-risk hospitalized patients to ensure that appropriate secondary prevention programs are initiated OBJECTIVE A population -based point-prevalence study was conducted to determine the prevalence of peripheral arterial disease ( PAD ) in Sweden , with special attention to critical limb ischemia and sex differences . METHODS An age-st and ardized r and omly selected population sample of 8000 women and men , aged 60 to 90 years , from four different regions in Sweden was invited to participate . The sample had the same age and gender distribution as the Swedish population in this age group . Participating subjects completed question naires on medical history , present medication , and symptoms , and their ankle-brachial index ( ABI ) was measured . Subjects were analyzed for presence of PAD according to reported symptoms and an ABI<0.9 . RESULTS A total of 5080 subjects were included , giving a participation rate of 64 % . The prevalence of any PAD , asymptomatic PAD , intermittent claudication , and severe limb ischemia was , respectively , 18 % ( 95 % confidence interval [ CI ] , 16 % to 20 % ) 11 % ( 9 % to 13 % ) , 7 % ( 6.5 to 7 % ) and 1.2 % ( 1 % to 1.5 % ) . Women had a higher prevalence than men when PAD was diagnosed with ABI only ; that is , asymptomatic PAD ( 12.6 % vs 9.4 % , P=.03 ) and severe limb ischemia ( 1.5 % vs 0.8 % , P<.008 ) . The prevalence of any PAD was 7.9 % in the age group 60 to 65 years and increased to 47.2 % among the age group 85 to 90 years . Severe limb ischemia occurred in 0.3 % in the youngest age group , was highest in the age group 80 to 84 years at 3.3 % , and declined to 2.5 % among the oldest . The prevalence of PAD differed between regions ( P<.0001 ) . CONCLUSIONS PAD is common in Sweden , and almost a fifth of all elderly individuals have some stage of this disease . Women are more often afflicted than men . The prevalence of severe ischemia , as a measure of critical limb ischemia , is about 1 % the population Aims : Peripheral arterial disease ( PAD ) can be diagnosed in asymptomatic stage , measuring ankle-brachial index ( ABI ) . Low ABI is an indicator of increased cardiovascular risk and its inclusion to traditional risk factors can improve risk prediction . The objective of the present cross-sectional part of our large-scale , multicenter , observational study was to evaluate the prevalence of PAD in a large cohort of hypertensive patients . Methods and results : A total of 21 892 hypertensive men and women ( 9162 men ; mean age 61.45 years ) were included in our prospect i ve study in hypertension clinics . Clinical history , physical examination , and blood analysis were taken , and the ABI was measured with the Doppler method in all patients . The prevalence of PAD ( ABI ⩽0.9 ) was 14.4 % . In 15.6 % of the patients an ABI of 0.91–0.99 , and in 9.4 % of the patients high ABI ( > 1.3 ) was measured . In the low , moderate , high , and very high Systematic Coronary Risk Evaluation risk groups , the prevalence of low ABI was 8.1 , 11.1 , 16.3 , and 26 % , respectively . The prevalence of PAD was lower in hypertensive patients achieving their blood pressure target ( 9.6 vs. 16.8 % ; P < 0.001 ) . Conclusions : Asymptomatic PAD was highly prevalent in the studied hypertensive population . The use of ABI screening may improve cardiovascular risk prediction . Optimal blood pressure goal values in PAD patients and cardiovascular morbidity/mortality data will be evaluated after the 5-year long prospect i ve phase of the Evaluation of Ankle-Brachial Index in Hungarian Hypertensives program Background Peripheral arterial disease ( PAD ) of the lower limbs is a cardiovascular disease highly prevalent particularly in the asymptomatic form . Its prevalence starts to be a concern in low coronary risk countries like Spain . Few studies have analyzed the relationship between ankle-brachial index ( ABI ) and cardiovascular morbi-mortality in low cardiovascular risk countries like Spain where we observe significant low incidence of ischemic heart diseases together with high prevalence of cardiovascular risk factors . The objective of this study is to determine the relationship between pathological ABI and incidence of cardiovascular events ( coronary disease , cerebrovascular disease , symptomatic aneurism of abdominal aorta , vascular surgery ) and death in the > 49 year population -based cohort in Spain ( ARTPER ) . Methods  Baseline ABI  was measured in 3,786 r and omly selected patients from 28 Primary Health Centers in Barcelona , distributed as : ABI<0.9 peripheral arterial disease ( PAD ) , ABI ≥1.4 arterial calcification ( AC ) , ABI 0.9 - 1.4 healthy ; and followed during 4 years . Results 3,307 subjects were included after excluding those with previous vascular events . Subjects with abnormal ABI were older with higher proportion of men , smokers and diabetics . 260 people presented cardiovascular events ( incidence 2,117/100,000 person-years ) and 124 died from any cause ( incidence 978/100,000 person-years ) . PAD had two-fold greater risk of coronary disease ( adjusted hazard ratio ( HR ) = 2.0 , 95 % confidence interval ( CI ) 1.3 - 3.2 ) and increased risk of vascular surgery ( HR = 5.6 , 95%CI 2.8 - 11.5 ) and mortality ( HR = 1.8 , 95%CI 1.4 - 2.5 ) . AC increased twice risk of cerebrovascular events ( HR = 1.9 , 95%CI 1.0 - 3.5 ) with no relationship with ischemic heart disease . Conclusions PAD increases coronary disease risk and AC cerebrovascular disease risk in low cardiovascular risk Mediterranean population . ABI could be a useful tool to detect patients at risk in Primary Health Care
No significant associations were found for hip flexion strength , WIQ distance score , or WIQ speed score with mortality .
CONCLUSIONS A number of lower extremity performance measures are prognostic markers for mortality in PAD and may be useful clinical tools for identifying patients at higher risk of death .
BACKGROUND Peripheral artery disease ( PAD ) is associated with impaired mobility and a high rate of mortality .
The aim of this systematic review was to investigate whether reduced lower extremity performance was associated with an increased incidence of  cardiovascular and all-cause mortality in people with PAD .