Peripheral arterial disease and subsequent cardiovascular mortality. A strong and consistent association.

In this issue of Circulation, Davey Smith and colleagues1 report the association of intermittent claudication with subsequent mortality among more than 18,000 men in the Whitehall Study. Intermittent claudication was assessed by self-administration of the brief and simple London School of Hygiene and Tropical Medicine questionnaire, better known as the Rose Questionnaire after its author.2 This questionnaire is the epidemiological standard for assessment of angina, infarction pain, and intermittent claudication. The Whitehall Study confirms earlier reports of a doubling of mortality and a significant reduction of life expectancy in subjects with symptoms of peripheral arterial disease (PAD).3-7 Most of this increase in mortality is due to cardiovascular disease. A population-based study from our institution confirmed that Rose claudication, called probable claudication in the Whitehall Study, doubled the risk of