Abstract-To assess the age-and sex-specific prevalence of peripheral arterial disease (PAD) and intermittent claudication (IC) in an elderly population, we performed a population-based study in 7715 subjects (40% men, 60% women) aged 55 years and over. The presence of PAD and IC was determined by measuring the ankle-arm systolic blood pressure index (AAI) and by means of the World Health Organization/Rose questionnaire, respectively. PAD was considered present when the AAI was Ͻ0.90 in either leg. The prevalence of PAD was 19.1% (95% confidence interval, 18.1% to 20.0%): 16.9% in men and 20.5% in women. Symptoms of IC were reported by 1.6% (95% confidence interval, 1.3% to 1.9%) of the study population (2.2% in men, 1.2% in women). Of those with PAD, 6.3% reported symptoms of IC (8.7% in men, 4.9% in women), whereas in 68.9% of those with IC an AAI below 0.90 was found. Subjects with an AAI Ͻ0.90 were more likely to be smokers, to have hypertension, and to have symptomatic or asymptomatic cardiovascular disease compared with subjects with an AAI of 0.90 or higher. The authors conclude that the prevalence of PAD in the elderly is high whereas the prevalence of IC is rather low, although both prevalences clearly increase with advancing age. Key Words: atherosclerosis Ⅲ elderly Ⅲ intermittent claudication Ⅲ peripheral arterial disease Ⅲ cardiovascular risk P eripheral arterial disease refers to the manifestation of atherosclerosis in the lower limb distal to the aortic bifurcation. When PAD becomes symptomatic, patients often present with complaints of IC: "cramping," "fatigue," or "aching" in the calf of the leg, induced by walking and relieved by standing still. In Ϸ25% of patients with IC, there is a progression to critical ischemia, eg, rest pain and gangrene, that may eventually necessitate amputation. 1,2Several studies have demonstrated that patients with PAD, both with and without symptoms of IC, [3][4][5] are at an increased risk of cardiovascular morbidity and mortality compared with subjects without PAD. 4,6 -9 In comparison to the number of reports on other manifestations of atherosclerotic disease, however, relatively few population-based studies on the prevalence of PAD and IC have been performed. We assessed the prevalence of PAD and IC in a large population-based study including 7715 subjects aged 55 years and over. MethodsThis study is part of The Rotterdam Study, a prospective follow-up study designed to investigate determinants of the occurrence and progression of chronic diseases in the elderly. Emphasis is on four areas of research: cardiovascular diseases, neurogeriatric diseases, locomotor diseases, and ophthalmologic diseases. The rationale and design of the study have been described previously. 10All individuals aged 55 years and over living in a suburb of Rotterdam, the Netherlands (a total of 10 275 subjects), were invited to participate in the Rotterdam Study. Baseline measurements were compiled after an extensive interview at the participant's home and two visits to the research cente...

Assessment of a wide range of atherosclerotic risk factors enabled us to quantify the relative importance of each factor as determinant for PAD. In total, 69% of the occurrence of PAD is attributable to cardiovascular risk factors measured in our study; smoking accounted for most (etiologic fraction, 18.1%). The results suggest that preventive management of PAD should be directed at systolic blood pressure, fibrinogen level, smoking, high-density lipoprotein cholesterol level, and diabetes mellitus. Arch Intern Med. 2000;160:2934-2938

Moderate alcohol consumption is associated with a reduced risk of cardiovascular disease. Data on alcohol consumption and atherosclerosis are scarce. To determine the association between alcohol consumption and risk of peripheral arterial disease, the authors carried out a cross-sectional study (1990-1993) in the population-based Rotterdam Study among men and women aged 55 years or over. Data on alcohol consumption and peripheral arterial disease, as measured by the ankle/brachial blood pressure index, were available for 3,975 participants without symptomatic cardiovascular disease. Male drinkers consumed beer, wine, and liquor, while female drinkers consumed predominantly wine and fortified wine types. An inverse relation between moderate alcohol consumption and peripheral arterial disease was found in women but not in men. Because of residual confounding by smoking, analyses were repeated in nonsmokers. In nonsmoking men, odds ratios were 0.86 (95% confidence interval (CI): 0.46, 1.63) for daily alcohol consumption up to and including 10 g, 0.75 (95% CI: 0.37, 1.55) for 11-20 g, and 0.68 (95% CI: 0.35, 1.34) for more than 20 g, compared with nondrinking. In nonsmoking women, corresponding odds ratios were 0.65 (95% CI: 0.48, 0.87), 0.66 (95% CI: 0.42, 1.05), and 0.41 (95% CI: 0.21, 0.77), respectively. In conclusion, an inverse association between alcohol consumption and peripheral arterial disease was found in nonsmoking men and women.

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