The practical management of claudication

As a marker for cardiovascular disease it needs active treatment

The management of patients with intermittent claudication has focused on improving symptoms caused by restricted blood flow through a limb. However, the goals of managing the condition have recently been broadened to include prevention of coronary and cerebrovascular events.

Intermittent claudication is underrecognised as a risk factor for coronary and cerebrovascular events. Sixty per cent of people with claudication die from coronary heart disease, and 10% of them die from stroke.1 Treating the person with claudication, therefore, is likely to pay high dividends in terms of reducing deaths from myocardial infarction and stroke. Morbidity and mortality in these patients can be improved by various strategies.

Exercise is widely held to be beneficial to patients with intermittent claudication, but it has been applied with little enthusiasm. In experimental models, however, exercising ischaemic muscle improved muscle performance within a short period of time. A meta-analysis of 21 studies of the effects of exercise on patients with intermittent claudication suggested that the average improvement in the distance that patients could walk was 122%.2 Programmes in which …