Abstract 18553: Different Leg Symptoms and the Presence of Peripheral Artery Disease in the Community: The Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Study

Abstract

Introduction: Intermittent claudication is manifestation of lower extremity peripheral artery disease (PAD). However, most patients with PAD either have atypical leg symptoms or no symptoms. To what extent leg symptoms are associated with the presence of PAD in the community is unknown. Methods: We studied 8,402 HCHS/SOL participants aged 45 and older (mean age 56.2 years, 54% female) without a clinical diagnosis of PAD. We categorized leg symptoms with walking into: (a) typical calf pain (calf pain on exertion relieved within 10 min after stopping); (b) atypical calf pain (same as (a) except no quick relief after 10 min); (c) non-calf pain (exertional leg pain but not in calf); and (d) leg pain at rest (ever pain during standing or sitting) based on a questionnaire. PAD was defined as an ankle-brachial index (ABI) ≤0.9. We first quantified the associations of leg symptoms with the presence of PAD using multivariable logistic regression. Then, we assessed the validity of different leg symptoms to identify PAD. All analyses accounted for survey weighting. Results: The prevalence of PAD was 4.8% (95% CI 4.1-6.0%). The prevalence of leg symptoms are displayed in Figure 1A (e.g., 1.9% for typical calf pain). In multivariable logistic models, only typical calf pain was significantly associated with PAD, and its adjusted OR exceeded 5 (5.52 [95% CI 2.60-11.7], Figure 1A). In terms of validity, typical calf pain had 98.5% specificity, but the sensitivity was ~10% (Figure 1B) and the positive predictive value was 24.1%. The c-statistic of this leg symptom classification for detecting PAD was 0.58. Conclusions: In Hispanics/Latinos without clinical history of PAD, only typical calf pain on exertion was robustly associated with the presence of PAD. However, the limited positive predictive value and discrimination indicate the need to optimize the target population and/or further refine leg symptoms to utilize them to detect PAD in the community.