One simple claudication question as first step in Peripheral Arterial Disease (PAD) screening: A meta-analysis of the association with reduced Ankle Brachial Index (ABI) in 27,945 subjects

Autoři: Arne Georg Kieback aff001;  Christine Espinola-Klein aff002;  Claudia Lamina aff003;  Susanne Moebus aff004;  Daniel Tiller aff005;  Roberto Lorbeer aff006;  Andreas Schulz aff007;  Christa Meisinger aff008;  Daniel Medenwald aff005;  Raimund Erbel aff004;  Alexander Kluttig aff005;  Philipp S. Wild aff010;  Florian Kronenberg aff003;  Knut Kröger aff013;  Till Ittermann aff014;  Marcus Dörr aff015
Působiště autorů: Kantonsspital Aarau- Medizinische Universitätsklinik, Angiologie, Aarau, Switzerland aff001;  University Medicine Mainz—Department of Angiology, Mainz, Germany aff002;  Medical University of Innsbruck—Institute of Genetic Epidemiology, Department of Genetics and Pharmacology, Innsbruck, Austria aff003;  Universitätsklinikum Essen (AöR), Institut für Medizinische Informatik, Biometrie und Epidemiologie (IMIBE), Essen, Germany aff004;  Martin-Luther-University Halle-Wittenberg—Institute of Medical Epidemiology, Biostatistics and Informatics, Halle (Saale), Germany aff005;  Ludwig Maximilian University Hospital—Department of Clinical Radiology, Munich, Germany aff006;  University Medical Center of the Johannes Gutenberg-University Mainz, Center for Cardiology I, Mainz, Germany aff007;  Helmholtz Zentrum München—German Research Center for Environmental Health (GmbH)—Institute of Epidemiology II, Neuherberg, Germany aff008;  Chair of Epidemiology, Ludwig-Maximilians-Universität München, UNIKA-T Augsburg Augsburg, Germany aff009;  University Medical Center of the Johannes Gutenberg-University Mainz, Preventive Cardiology and Preventive Medicine, Center for Cardiology, Mainz, Germany aff010;  University Medical Center of the Johannes Gutenberg-University Mainz, Center for Thrombosis and Hemostasis (CTH), Mainz, Germany aff011;  DZHK (German Center for Cardiovascular Research), partner site RhineMain, Mainz, Germany aff012;  Helios Klinikum Krefeld—Klinik für Gefäßmedizin, Krefeld, Germany aff013;  University Medicine Greifswald, Institute for Community Medicine, Greifswald, Germany aff014;  DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany aff015;  University Medicine Greifswald, Department of Internal Medicine B, Greifswald, Germany aff016
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0224608


Purpose and methods

A meta-analysis using data from seven German population-based cohorts was performed by the German Epidemiological consortium of Peripheral Arterial Disease (GEPArD) to investigate whether one question about claudication is more efficient for PAD screening than established questionnaires. Claudication was defined on the basis of the answer to one question asking for pain in the leg during normal walking. This simple question was compared with established questionnaires, including the Edinburgh questionnaire. The associations of claudication with continuous ABI values and decreased ABI were analyzed by linear and logistic regression analysis, respectively. The results of the studies were pooled in a random effect meta-analysis, which included data from 27,945 individuals (14,052 women, age range 20–84 years).


Meta-analysis revealed a significant negative association between claudication and ABI, which was stronger in men (β = -0.07; 95%CI -0.10, -0.04) than in women (β = -0.02; 95%CI -0.02, -0.01). Likewise, the presence of claudication symptoms was related to an increased odds of a decreased ABI in both men (Odds ratio = 5.40; 95%CI 4.20, 6.96) and women (Odds ratio = 1.99; 95%CI 1.58, 2.51).


Asking only one question about claudication was able to identify many individuals with a high likelihood of a reduced ABI with markedly higher sensitivity and only slightly reduced specificity compared to more complex questionnaires. At least in men, this question should be established as first screening step.

Klíčová slova:

Death rates – General practitioners – Peripheral vascular disease – Physicians – Questionnaires – Walking


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