AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Clinical Characteristics, Leg Symptoms, and Walking Impairment in Peripheral Artery Disease
By Mickus S, Zhang D, McDermott MM
Background: Approximately 70 to 90% of people with lower-extremity peripheral artery disease (PAD) do not have classic intermittent claudication symptoms, which may contribute to under-diagnosis of PAD. This study evaluated associations between severity of ischemic leg symptoms measured by the Walking Impairment Questionnaire (WIQ) with objectively measured walking impairment, measured by the 6-minute walk test. Clinical characteristics associated with ischemic leg symptom severity were also identified. Methods: Baseline data from 20 clinical trials of therapeutic interventions for participants with PAD were combined. All clinical trials measured both the WIQ and 6-minute walk at baseline. Participants were categorized by perceived degree of walking difficulty associated with specific leg symptoms that limited walking on a 0-4 scale (0-most) (measured by the WIQ). Within each category of leg symptom, associations between symptom severity and clinical characteristics were evaluated using general linear regression modeling and Cochran-Armitage Trend Test. Similar analyses were used to evaluate associations of leg symptom severity with 6-minute walk distance and proportion of participants who prematurely rested during the 6-minute walk. Results: The study included 1,703 unique participants with PAD (44.5% female, 47.9% Black, mean age of 70.49 (SD: 9.46)). Younger age, current cigarette smoking, and lower ankle brachial index (ABI) values were associated with more severe ischemic leg symptoms, measured by the WIQ (Table). More severe ischemic leg symptoms were associated with shorter distances in the 6-minute walk and higher rates of stopping during the 6-minute walk. Many PAD participants without history of lower extremity arthritis reported difficulty walking due to pain, stiffness, or aching in the hips and knees (Table). Conclusions: Among 1,703 PAD participants, younger age and cigarette smoking were associated with more ischemic leg symptoms. Many PAD patients reported that pain, stiffness, and aching in the knee and hip joints limited their walking ability. These atypical leg symptoms likely contribute to under-diagnosis of PAD.