Peripheral arterial disease epidemiology and demographics
Editors-in-Chief: C. Michael Gibson, M.D., Beth Israel Deaconess Medical Center, Boston, MA; Robert G. Schwartz, M.D. [1], Piedmont Physical Medicine and Rehabilitation, P.A.; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Overview
Epidemiology and Demographics
- Lower Extremity PAD - Prevalence
- Affects a large proportion of most adult populations worldwide
- Increases with age and with exposure to atherosclerotic risk factors.
- Defined by:
- Claudication as a symptomatic marker
- Abnormal ankle-to brachial systolic blood pressure index (Ankle-Brachial Index or ABI)
- Underlying atherosclerosis risk factor profile
- Presence of other concomitant manifestations of atherosclerosis
Prevalence and Incidence
The prevalence of peripheral vascular disease in people aged over 55 years is 10%–25% and increases with age; 70%–80% of affected individuals are asymptomatic; only a minority ever require revascularisation or amputation.[1]
In the USA peripheral arterial disease 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.[2]
The incidence of symptomatic PVD increases with age, from about 0.3% per year for men aged 40–55 years to about 1% per year for men aged over 75 years. The prevalence of PVD varies considerably depending on how PAD is defined, and the age of the population being studied.[1] Diagnosis is critical, as people with PAD have a four to five times higher risk of heart attack or stroke.
In Western Australia, the prevalence of symptomatic disease at around 60 years of age is about 5%.[3]
A study from the NHANES 1999–2000 data found that PVD affects approximately 5 million adults.[2]
The Diabetes Control and Complications Trial and U.K. Prospective Diabetes Study trials in people with type 1 and type 2 diabetes, respectively, demonstrated that glycemic control is more strongly associated with microvascular disease than macrovascular disease. It may be that pathologic changes occurring in small vessels are more sensitive to chronically elevated glucose levels than is atherosclerosis occurring in larger arteries.[4]
If all cases of symptomatic leg pain that have a peripheral arterial disease aspect to it are considered then the incidence of peripheral arterial disease is much higher then cited above. Numerous studies have shown hardening of the arteries in teenagers and a large percentage of patients with vascular risk factors will have at least early changes if investigated. When ever a patient has vascular risk factors and presents with a condition that includes chronic or complex leg pain (restless legs, sciatica, limb swelling) functional studies such as exercise or stress plethysmography should be considered as part of the diagnosis and treatment protocol [3].
References
- ↑ 1.0 1.1 "Peripheral arterial disease prevention and prevalence". Peripheral Arterial Disease. 2007. Retrieved 2007-12-03. Unknown parameter
|publsiher=ignored (|publisher=suggested) (help); Unknown parameter|month=ignored (help) - ↑ 2.0 2.1 A. Richey Sharrett, MD, DRPH (2007). "Peripheral arterial disease prevalence". Peripheral Arterial Disease. Retrieved 2007-12-03. Unknown parameter
|publsiher=ignored (|publisher=suggested) (help); Unknown parameter|month=ignored (help) - ↑ Hiatt W, Hoag S, Hamman R. (1995). "Effect of diagnostic criteria on the prevalence of peripheral arterial disease". Effect of diagnostic criteria on the prevalence of peripheral arterial disease. Retrieved 2007-12-03. Unknown parameter
|publsiher=ignored (|publisher=suggested) (help); Unknown parameter|month=ignored (help) - ↑ Elizabeth Selvin, PHD, MPH, Keattiyoat Wattanakit, MD, MPH, Michael W. Steffes, MD, PHD, Josef Coresh, MD, PHD and A. Richey Sharrett, MD, DRPH (2005). "HbA1c and Peripheral Arterial Disease in Diabetes". The Atherosclerosis Risk in Communities study. Retrieved 2007-12-03. Unknown parameter
|publsiher=ignored (|publisher=suggested) (help); Unknown parameter|month=ignored (help)