Bowlin S J, Medalie J H, Flocke S A, Zyzanski S J, Goldbourt U
Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, OH 44106-4945.
Am J Epidemiol. 1994 Sep 1;140(5):418-30. doi: 10.1093/oxfordjournals.aje.a117264.
Intermittent claudication, myocardial infarction, and angina pectoris share many epidemiologic and biologic features. Yet few large cohort studies describing the prevalence, incidence, and risk factors for intermittent claudication have been done. The authors evaluated intermittent claudication in 10,059 Israeli men aged 40-65 years, of whom 8,343 were free of coronary heart disease and symptoms of peripheral vascular disease; this latter group was followed for 5 years from 1963 to 1968. Prevalent and incident cases of intermittent claudication were defined by the London School of Hygiene Cardiovascular Disease Questionnaire, and all cardiovascular disease risk factor evaluations were standardized. Baseline prevalence was 27.0/1,000 (211/10,029). A total of 360 previously healthy men developed intermittent claudication for a crude 5-year incidence rate of 43.1/1,000 (360/8,343) or a crude annual incidence of 8.6/1,000. Following univariate analysis with demographic, physiologic, psychosocial, and other cardiovascular disease variables, logistic regression was used to identify risk factors for intermittent claudication. These were the following: > 20 cigarettes per day, odds ratio (OR) = 2.02, 95% confidence interval (CI) 1.54-2.66; serum cholesterol (50-mg/dl difference), OR = 1.35, 95% CI 1.18-1.54; 11-20 cigarettes per day, OR = 1.69, 95% CI 1.24-2.30; anxiety (high vs. low), OR = 1.85, 95% CI 1.29-2.65; socioeconomic status, OR = 1.82, 95% CI 1.26-2.64; and diabetes, OR = 1.85, 95% CI 1.25-2.75. Other significant predictors of smaller magnitude included in the regression were age, psychosocial coping factors, Quetelet's index, and exsmoking. The risk factors for intermittent claudication were a blend of those related to myocardial infarction (smoking, cholesterol, diabetes, but not hypertension) and others related to angina pectoris but not to myocardial infarction (stress and coping variables). There is reason to believe that preventing or modifying these factors will prove effective in altering the natural history and clinical outcomes of peripheral vascular disease as shown in other forms of atherosclerosis.
间歇性跛行、心肌梗死和心绞痛有许多流行病学和生物学特征。然而，很少有大型队列研究描述间歇性跛行的患病率、发病率和危险因素。作者对10059名年龄在40 - 65岁的以色列男性进行了间歇性跛行评估，其中8343人无冠心病和周围血管疾病症状；从1963年到1968年，对后一组人群进行了5年的随访。间歇性跛行的现患和新发病例由伦敦卫生学院心血管疾病问卷定义，所有心血管疾病危险因素评估均标准化。基线患病率为27.0/1000（211/10029）。共有360名此前健康的男性出现间歇性跛行，粗5年发病率为43.1/1000（360/8343），或粗年发病率为8.6/1000。在对人口统计学、生理学、心理社会和其他心血管疾病变量进行单因素分析后，使用逻辑回归来确定间歇性跛行的危险因素。这些因素如下：每天吸烟>20支，比值比（OR）=2.02，95%置信区间（CI）1.54 - 2.66；血清胆固醇（相差50mg/dl），OR = 1.35，95%CI 1.18 - 1.54；每天吸烟11 - 20支，OR = 1.69，95%CI 1.24 - 2.30；焦虑（高与低），OR = 1.85，95%CI 1.29 - 2.65；社会经济地位，OR = 1.82，95%CI 1.26 - 2.64；以及糖尿病，OR = 1.85，95%CI 1.25 - 2.75。回归中纳入的其他较小幅度的显著预测因素包括年龄、心理社会应对因素、体重指数和既往吸烟史。间歇性跛行的危险因素是与心肌梗死相关的因素（吸烟、胆固醇、糖尿病，但不包括高血压）和与心绞痛相关但与心肌梗死无关的其他因素（压力和应对变量）的混合。有理由相信，预防或改变这些因素将被证明能有效改变周围血管疾病的自然史和临床结局，正如在其他形式的动脉粥样硬化中所显示的那样。
