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

• Published in: PloS one Vol. 14; no. 11; p. e0224608
• Main Authors: Kieback, Arne Georg, Espinola-Klein, Christine, Lamina, Claudia, Moebus, Susanne, Tiller, Daniel, Lorbeer, Roberto, Schulz, Andreas, Meisinger, Christa, Medenwald, Daniel, Erbel, Raimund, Kluttig, Alexander, Wild, Philipp S., Kronenberg, Florian, Kröger, Knut, Ittermann, Till, Dörr, Marcus
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 04.11.2019; Public Library of Science (PLoS)
• Subjects: Ankle; Ankle Brachial Index; Biology and Life Sciences; Cardiology; Cardiovascular disease; Cardiovascular diseases; Consortia; Data analysis; Diabetes; Epidemiology; Female; Gender differences; Health care; Humans; Informatics; Intermittent Claudication - diagnosis; Intermittent Claudication - etiology; Intermittent Claudication - physiopathology; Male; Mass Screening - methods; Medicine and Health Sciences; Meta-analysis; Morbidity; Mortality; Pain; People and Places; Peripheral Arterial Disease - complications; Peripheral Arterial Disease - diagnosis; Peripheral Arterial Disease - physiopathology; Physical Sciences; Population; Preventive medicine; Questionnaires; Questions; Regression analysis; Research and Analysis Methods; Screening; Sensitivity and Specificity; Sex Factors; Signs and symptoms; Smoking cessation; Surveys and Questionnaires; Walking; Walking - physiology; Austria; Germany
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0224608

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.