The magnitude of the problem of peripheral arterial disease: Epidemiology and clinical significance

The prevalence of lower extremity peripheral arterialdisease (PAD) varies across populations, based on thegroups studied and the detection methods used. Theankle-brachial index (ABI) is a more sensitive tool forPAD detection than is screening for intermittent claudication(IC); only about 10% to 30% of patients diagnosedwith PAD based on the ABI have classic symptomsof IC. The prevalence of PAD increases markedlywith older age and in persons with diabetes or a historyof smoking; prevalence also is elevated in persons withhyperlipidemia, hypertension, or chronic kidney disease. PAD is more prevalent in primary care medical practicesthan in community-dwelling populations. PAD (definedas an ABI< 0.90) is associated with a twofold to threefoldincreased risk of cardiovascular mortality. Borderline and low-normal ABI values, as well as elevated ABI values (> 1.30 or > 1.40), are increasingly recognized as being associated with elevated cardiovascular mortality. Persons with PAD have significantly increased functional impairment and elevated rates offunctional decline relative to those without PAD.