Impaired Peripheral Circulation in Veterans with Claudication is Associated with Smoking

Makoto Umeda

doi:10.4172/2329-9495.1000133

Abstract

We compared the peripheral vascular function of veterans and non-veterans with peripheral artery disease (PAD) and claudication. The circulation of the lower extremities was assessed under rest and reactive hyperemia conditions in 413 veterans and in 83 non-veterans. Veterans had more severe PAD as measured by a lower ankle/ brachial index (p<0.001). Following the occlusive test, veterans had a greater relative percentage decrease in ankle systolic blood pressure (p=0.015), a greater percentage decrease in calf transcutaneous oxygen tension (p=0.035), and a blunted percentage increase in calf blood flow (p=0.031). After adjustment for current smoking status, these measures were no longer statistically different between the veterans and non-veterans. We conclude that veterans with PAD and claudication have greater impairments in macrovascular and microvascular function of the lower extremities, and greater severity of PAD than compared to non-veterans, and that these factors were primarily associated with their higher prevalence of smoking. The greater compromise in peripheral vascular measures in veterans is particularly noteworthy given that the prevalence of diabetes, hypertension, and dyslipidemia were not higher.

Highlights

Peripheral artery disease (PAD) is prevalent in eight million men and women in the United States and in more than 12% of community dwelling people aged 65 years and older [1,2]
Veterans had a higher prevalence of smoking (p
Greater impairments in microvascular function were seen in the veterans, as they had lower increases in the absolute and percentage changes in calf blood flow from rest to hyperemia than the nonveterans We have previously shown that calf blood flow measures are associated with endothelial function in patients with PAD, as measured by the percentage change in brachial artery diameter [23]

Summary

Introduction

Peripheral artery disease (PAD) is prevalent in eight million men and women in the United States and in more than 12% of community dwelling people aged 65 years and older [1,2]. The cost associated with PAD is comparable to, if not higher than cardiac dysrhythmias, congestive heart failure and cerebrovascular disease, averaging $3.9 billion for total Medicare paid PAD-related care annually [6]. Many of those with PAD are physically limited by ambulatory leg pain, resulting in ambulatory dysfunction, impaired physical function lower physical activity levels and even worse healthrelated quality of life scores than in individuals with coronary artery disease and congestive heart failure [7,8,9,10,11,12,13]. PAD patients have increased rates of functional decline and mobility loss compared to those without PAD [9,10,14]

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