Background: The epidemiology of intermittent claudication in the primary care settings has been studied almost exclusively in northern European and northern American populations. This article compares the results of the Peripheral Arteriopathy and Cardiovascular Events (PACE) study, the first survey in Italy to assess the prevalence, comorbidity and natural history of intermittent claudication, with those observed in other western countries.
Methods: From the lists of seven general practitioners, all patients aged 40-80 years (n = 4352) received a Rose questionnaire. In those reporting leg pain while leg pain while walking (n = 760), Doppler examination was performed. Intermittent claudication was defined as an ankle/branchial index of < 0.90, or reduced flow velocity. For each claudicant, three age- and sex-matched controls were randomly selected from patients negative to the questionnaire.
Results: The prevalence of both intermittent claudication (1.6%) and associated cardiovascular disease (34%) tended to be lower in Italy than in the United Kingdom, Netherlands, and North America. Conversely, no between country difference was observed with respect to mortality, which was very high (relative risk 4.08; 95% confidence interval 1.50-10.84, p = 0.006) in the PACE claudicants.
Conclusions: In this regard it is noteworthy that these patients, who were managed almost exclusively by their general practitioner were undertreated with respect to the use of antiplatelet therapy and correction of risk factors. There is need to alert them to this topic.