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Functional status measured by walking impairment questionnaire and cardiovascular risk prediction in peripheral arterial disease: results of the Peripheral Arteriopathy and Cardiovascular Events (PACE) study

Department of Clinical Medicine and Cardiovascular and Immunological Sciences, University of Naples ‘Federico II’, Naples, Italy

Gregorio Brevetti

Department of Clinical Medicine and Cardiovascular and Immunological Sciences, University of Naples ‘Federico II’, Naples, Italy, brevetti{at}unina.it

Giusy Sirico

Department of Clinical Medicine and Cardiovascular and Immunological Sciences, University of Naples ‘Federico II’, Naples, Italy

Antonio Silvestro

Department of Clinical Medicine and Cardiovascular and Immunological Sciences, University of Naples ‘Federico II’, Naples, Italy

Giuseppe Giugliano

Department of Clinical Medicine and Cardiovascular and Immunological Sciences, University of Naples ‘Federico II’, Naples, Italy

Massimo Chiariello

Department of Clinical Medicine and Cardiovascular and Immunological Sciences, University of Naples ‘Federico II’, Naples, Italy

The prognostic impact of the functional status of patients with intermittent claudication is still obscure. From the lists of seven general practitioners, we identified all subjects aged 40-80 years (n = 4352). Of those reporting leg symptoms while walking on the Rose questionnaire (n = 760), 60 had a qualifying diagnosis of peripheral arterial disease (PAD). All of them received the Walking Impairment Questionnaire (WIQ). For each patient affected by PAD, three sex- and age-matched controls were selected randomly. After a 24-month follow-up, survival curves showed that PAD patients with WIQ scores > median had a higher cardiovascular risk than controls, and patients with WIQ scores < median had an even poorer prognosis (p < 0.001 for all WIQ domains). In PAD, after adjustment for age, sex, ankle-brachial index and comorbidity, two WIQ domains (ie walking speed and stairclimbing) were associated with cardiovascular events. The cardiovascular risk of claudicants who had a score > median for at least three WIQ domains was intermediate versus the risk of controls and PAD patients with a WIQ score < median, also when adjusted for the covariates indicated above (RR = 3.26, p = 0.019). In intermittent claudication, a worse functional status entails a greater risk of ischemic events versus low functional impairment.

Key Words: cardiovascular risk • functional status • intermittent claudication • peripheral arterial disease • walking impairment questionnaire

Vascular Medicine, Vol. 11, No. 3, 147-154 (2006)
DOI: 10.1177/1358863x06074830


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