The prevalence of asymptomatic and unrecognized peripheral arterial occlusive disease

Abstract

Background. The prevalence of peripheral arterial occlusive disease (PAOD), including asymptomatic cases and cases unknown to the general practitioner (GP) was estimated in 18,884 men and women, aged 45-74 years, on the list of 18 general practice centres (GPC). Methods. The study population (n = 3171) consisted of a stratified sample of the total population. In the GPC data were collected on intermittent claudication (IC), peripheral pulses, vascular risk factors, cardio- and cerebrovascular disease (CCVD) and the ankle brachial systolic pressure ratio (AB ratio) and PAOD was defined as an AB ratio < 0.95 on two consecutive occasions. Results were recalculated for the total population. Results. The prevalence of PAOD was 6.9% (95% confidence interval [CI] : 5.7-8.2%), of which one-third (2.2%) had an AB ratio < 0.75. The prevalence of IC was 6.6% (95% CI :5.2-7.9%), a quarter of which (1.6%) met the classic WHO criteria. Peripheral arterial occlusive disease did not occur significantly more often among men than among women but men suffered more often from an advanced stage of PAOD. Of all PAOD cases, 22% were symptomatic. The proportion of symptomatic cases correlated positively with higher age, male gender and lower AB ratio. Among asymptomatic PAOD cases the prevalence of concomitant CCVD was three to four times as high as in the group of subjects without PAOD. Of all PAOD cases 68% were unknown to the GP and this group mainly represented less advanced cases of atherosclerosis. However, among PAOD cases with an AB ratio < 0.75, 42% were unknown to the GP. Conclusions. Our data on asymptomatic and unknown PAOD cases show that GPs can still enhance their efforts towards (secondary) prevention of atherosclerosis.