Peripheral Arterial Disease (PAD)

• Peripheral arterial disease (PAD) affects about 8 million Americans and is associated with significant morbidity and mortality. (JAMA 2001;286:1317-24)
• PAD affects 12 - 20 percent of Americans age 65 and older. Despite its prevalence and cardiovascular risk implications, only 25 percent of PAD patients are undergoing treatment. (J Vasc Interv Radiol. 2002;13:7-11.)
• In the general population, only about 10 percent of persons with PAD have the classic symptoms of intermittent claudication (intermittent leg pain). About 40 percent do not complain of leg pain, while the remaining 50 percent have a variety of leg symptoms different from classic claudication. (JAMA. 2001;286:1317-1324; Circulation. 1985;71:516- 522.) However, in an older, disabled population of women, as many as two-thirds of individuals with PAD had no leg symptoms associated with exercise or exertion. (Circulation. 2000;101:1007-1012.)
• Intermittent claudication is present in less than 1 percent of individuals under age 50 and approximately 5 percent or more in those over age 80. (Circulation. 2006 Mar 21;113[11]:e463-e654.)
• The risk factors for PAD are similar to those for coronary heart disease (CHD), although diabetes and cigarette smoking are particularly strong risk factors for PAD. (Circulation. 2006 Mar 21;113[11]: e463-654; Am J Epidemiol. 1989;129:1110-1119.)
• Persons with PAD have impaired function and quality of life. This is true even for persons who do not report leg symptoms. Furthermore, PAD patients, including those who are asymptomatic, experience significant decline in lower extremity functioning over time. (Ann Intern Med. 2002;136:873- 883; JAMA. 2004;292:453-461.)
• PAD is a marker for systemic atherosclerotic disease. Persons with PAD, compared to those who do not have it, have four to five times the risk of dying of a CVD event, resulting in two to three times higher total mortality risk. (NEJM. 1992;326:381-6; JAMA. 1993;270:487-489.)
• In the FHS, the annual mortality rate was almost four times greater in subjects with intermittent claudication. In a major cohort study, investigators observed a risk for all-cause mortality in these subjects that was 3.1 times higher than that for patients without PAD. In addition, PAD patients had a 5.9-times higher risk for death from cardiovascular disease (CVD) complications and a 6.6-times higher risk for death from CHD specifically. (Circulation. 2006 Mar 21;113[11]:e463- 654; Clin Cornerstone. 2002;4:1-15.)
• African-American ethnicity was a strong and independent risk factor for PAD. PAD was not attributable to higher levels of diabetes, hypertension and body mass index. African Americans had a higher PAD prevalence than non-Hispanic whites. There was no evidence of a greater susceptibility of African Americans to CVD risk factors as a reason for their higher PAD prevalence. (Circulation. 2005;112:2703-2707.)
• Data from NHANES 1999 - 2000 show that even low blood levels of lead and cadmium may increase the risk of PAD. Exposure to these two metals is possible through cigarette smoke. The risk was 2.8 for high levels of cadmium and 2.9 for high levels of lead. The odds ratio of PAD for current smokers was 4.13 compared to people who had never smoked. (Circulation. 2004;109:3196-3201.)
• Results from the NHANES 1999 - 2000 survey of the NCHS showed a remarkably high prevalence of PAD among patients with renal insufficiency. (Circulation. 2004;109:320-323.)
• Available evidence suggests that the prevalence of PAD in persons of Hispanic origin is similar to or slightly higher than in Caucasians. (Circulation. 2005;112:2703-2707.)