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February 6, 2013

Medications for Improving Walking Performance in Peripheral Artery Disease: Still Miles to Go

Author Affiliations

Author Affiliations: Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois. Dr McDermott is also Contributing Editor, JAMA.

JAMA. 2013;309(5):487-488. doi:10.1001/jama.2013.89

Lower extremity peripheral artery disease (PAD) is a global health problem that will become increasingly prevalent as the world population lives longer with chronic disease. One report estimated that 1 in 16 Americans 40 years or older has PAD.1

Improving functional performance is a major treatment goal for patients with PAD. Men and women with PAD have greater functional impairment and more rapid functional decline than those without PAD. Among participants in the Walking and Leg Circulation Study (WALCS), a longitudinal observational study of 676 men and women (overall mean age, 71.0 years) with and without PAD, those with severe PAD, defined as an ankle brachial index less than 0.50, were 12 times more likely to become unable to walk continuously for 6 minutes at 2-year follow-up, compared with those with a normal ankle brachial index at baseline.2 At 5-year follow-up in the WALCS cohort, participants with severe PAD had a 4-fold increased risk of mobility loss, compared with participants without PAD at baseline. Participants with moderate and mild PAD, respectively, had a 3.82-fold and 3.22-fold increased risk of mobility loss at 5-year follow-up, compared with participants without PAD at baseline.3 The functional limitations experienced by patients with PAD are associated with poorer quality of life, increased hospitalization rates, higher mortality, and higher medical care costs.