Peripheral Arterial Disease
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Peripheral arterial disease (PAD) is defined as atherosclerotic occlusive disease of the peripheral arteries, most commonly in the lower extremities. Following coronary artery disease and cerebrovascular disease, PAD is the third leading source of atherosclerotic vascular morbidity. PAD manifests as intermittent claudication (IC) or atypical leg pain and is commonly diagnosed with a resting ankle-brachial index (ABI) of <0.90.
- Age: >50 years
- Sex: male > female (2:1)
- Impacts at least 8 million people in the United States
- Globally, an estimated >200 million people have PAD with increased prevalence in low- and middle-income countries.
- Annual incidence is 7.1/1,000 men and 3.6/1,000 women among all ages, per Framingham Heart Study.
- Incidence increases with age and the presence of cardiovascular risk factors.
- U.S. prevalence: 5.9% in adults >40
- Prevalence approaches 30% in high-risk populations.
- Higher prevalence and severity in African Americans and Hispanics
Etiology and Pathophysiology
- In PAD, arterial occlusion most commonly occurs secondary to atherosclerotic disease.
- Other etiologies include phlebitis, trauma, or autoimmune/vasculitic diseases.
- Arterial narrowing impairs the ability to adequately oxygenate muscle during periods of increased demand (i.e., exercise), causing claudication and exercise limitation.
- Reperfusion at rest following ischemia can result in multiple subsequent physiologic changes, including inflammation, oxidant stress, endothelial dysfunction, and mitochondrial injury.
Although several of the risk factors for PAD (as noted below) are heritable, genome-wide association studies isolating PAD-specific single nucleotide polymorphisms have not been as successful. This has been attributed to the increased clinical and genetic heterogeneity of PAD.
- Age >50 years
- Cigarette smoking
- Diabetes mellitus (DM)
- Chronic kidney disease (CKD)
- Heritable conditions: chylomicronemia, hypercholesterolemia, hyperhomocysteinemia, and pseudoxanthoma elasticum
- Regular aerobic exercise program
- Smoking cessation
- Blood pressure (BP) and diabetes control
- Statin therapy is indicated in those with clinical PAD for secondary prevention of atherosclerotic cardiovascular disease.
Commonly Associated Conditions
In addition to the aforementioned risk factors, PAD is associated with other forms of atherosclerotic disease including myocardial infarction (MI), transient ischemic attack (TIA), and cerebrovascular accident (CVA).