Promoting an increased awareness and standardized approaches in diagnosing and treating peripheral artery disease



Peripheral artery disease (PAD) is a global health problem and ranks among the top three causes of atherosclerotic cardiovascular disease, following coronary artery disease (CAD) and stroke. Recent data suggest that more than 200 million people have PAD worldwide (1). PAD is more common after the age of 50 years, and its prevalence increases with age, such that 1 in 5 patients by the age of 70 years have PAD.  It affects men and women equally; however, the prevalence of symptomatic or severe disease is higher among men than women. At any given age, the prevalence of PAD is 2-fold higher in African Americans than among whites.  Despite advances in contemporary therapy for atherosclerotic coronary disease, the prevalence of PAD continues to increase; such as, between 2000-2010 the prevalence of PAD has increased by ~15% in high-income countries and ~30% in low to middle income countries (2). Several observational analyses have highlighted the burden of PAD in the United States (US); for example, in a robust retrospective cohort analysis of 12 million adults in an insurance claims database in the US, the prevalence of PAD was 11% (3). In another analysis of primary care patients across the US, ~30% of patients who were ≥70 years of age or ≥50 years with a history of diabetes or smoking were reported to have PAD (4).

The presence of PAD is independently associated with increased morbidity and mortality. Even after adjusting for traditional risk factors, PAD is a strong predictor of systemic atherothrombotic events such as all-cause mortality, cardiovascular death, myocardial infarction, and stroke.  Furthermore, PAD also results in profound disability and poor quality of life due to claudication, ischemic rest pain, foot ulcers, acute limb ischemia, recurrent hospitalizations, need for revascularization, and amputation. Concerningly, recent reports from the global burden of disease database from developing and developed nations have shown that mortality and disability secondary to PAD has significantly increased over the last two decades (5). Despite the rising prevalence, the diagnosis of PAD is routinely ignored, and these patients are less frequently treated with evidence-based therapy for atherosclerotic disease than those with coronary disease.


  1. Criqui MH, Aboyans V. Epidemiology of peripheral artery disease. Circ Res. 2015 Apr 24;116(9):1509-26.
  2. Fowkes FG, Rudan D, Rudan I, et al. Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis. Lancet. 2013; 382:1329–1340.
  3. Nehler MR, Duval S, Diao L, et al. Epidemiology of peripheral arterial disease and critical limb ischemia in an insured national population. J Vasc Surg. 2014; 60:686–95.
  4. Hirsch AT, Criqui MH, Treat-Jacobson D, et al. Peripheral arterial disease detection, awareness, and treatment in primary care. JAMA. 2001;286(11):1317-1324.
  5. Sampson UK, Fowkes FG, McDermott MM, et al. Global and regional burden of death and disability from peripheral artery disease: 21 world regions, 1990 to 2010. Glob Heart. 2014; 9:145–158.e21.