Prevalence of and Risk Factors for Peripheral Arterial Disease in the United States: Results From the National Health and Nutrition Examination Survey, 1999–2000
Abstract
Background— Peripheral arterial disease (PAD) is associated with significant morbidity and mortality and is an important marker of subclinical coronary heart disease. However, estimates of PAD prevalence in the general US population have varied widely. Methods and Results— We analyzed data from 2174 participants aged 40 years and older from the 1999–2000 National Health and Nutrition Examination Survey. PAD was defined as an ankle-brachial index <0.90 in either leg. The prevalence of PAD among adults aged 40 years and over in the United States was 4.3% (95% CI 3.1% to 5.5%), which corresponds to ≈5 million individuals (95% CI 4 to 7 million). Among those aged 70 years or over, the prevalence was 14.5% (95% CI 10.8% to 18.2%). In age- and gender-adjusted logistic regression analyses, black race/ethnicity (OR 2.83, 95% CI 1.48 to 5.42) current smoking (OR 4.46, 95% CI 2.25 to 8.84), diabetes (OR 2.71, 95% CI 1.03 to 7.12), hypertension (OR 1.75, 95% CI 0.97 to 3.13), hypercholesterolemia (OR 1.68, 95% CI 1.09 to 2.57), and low kidney function (OR 2.00, 95% CI 1.08 to 3.70) were positively associated with prevalent PAD. More than 95% of persons with PAD had 1 or more cardiovascular disease risk factors. Elevated fibrinogen and C-reactive protein levels were also associated with PAD. Conclusions— This study provides nationally representative prevalence estimates of PAD in the United States, revealing that PAD affects more than 5 million adults. PAD prevalence increases dramatically with age and disproportionately affects blacks. The vast majority of individuals with PAD have 1 or more cardiovascular disease risk factors that should be targeted for therapy.
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The overall prevalence of PAD among individuals aged ≥40 years in the United States is between 4 and 10%.
“The overall prevalence of PAD among individuals aged ≥40 years in the United States is somewhere between 4 and 10%.[4][5][6]”
From Racial and Ethnic Disparities in Peripheral Artery Disease (2021) · cites this paper as [6]
Black race alone was associated with prevalent PAD at rates nearly 3× as high as NHW (odds ratio, 2.83).
“Black race alone was associated with prevalent PAD at rates nearly 3× as high as NHW (odds ratio, 2.83).”
From Racial and Ethnic Disparities in Peripheral Artery Disease (2021) · cites this paper as [6]
The risk for PAD in people with diabetes is higher than that in people without diabetes.
“The risk for PAD in people with diabetes is higher than that in people without diabetes (230-232).”
From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2025 (2025) · cites this paper as [230]
The risk for peripheral artery disease in people with diabetes is higher than in people without diabetes.
“The risk for PAD in people with diabetes is higher than that in people without diabetes (220–222).”
From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2026 (2026) · cites this paper as [220]
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Khan, N. A. (2006) · JAMA · doi:10.1001/jama.295.5.536 · Cited by 288 · see citing works
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Diabetes and peripheral artery disease: A review
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Hirsch, A. T., Murphy, T. P., Lovell, M. B., Twillman, G., Treat-Jacobson, D., Harwood, E. M., Mohler, E. R., Creager, M. A., Hobson, R. W., Robertson, R. M., et al. (2007) · Circulation · doi:10.1161/circulationaha.107.725101 · Cited by 273 · see citing works
“. .?”), ( 2 ) subject exposure to atherosclerosis risk factors (eg, “Do you have high blood pressure or are you Table 5. Perceived Consequences of PAD Among Those Aware of PAD by Demographic Characteristics in Response to the Question, “Based on What You Know or Have Heard, What Can PAD Lead to if Not Treated?””
BackgroundOstchega, Y., Paulose‐Ram, R., Dillon, C. F., Gu, Q., & Hughes, J. P. (2007) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2007.01123.x · Cited by 273 · see citing works
Peripheral Arterial Disease in Patients With End-Stage Renal Disease
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“At baseline, PAD was determined by chart review and included a diagnosis for at least 1 of the following conditions: (1) prior diagnosis of PAD; (2) intermittent claudication; (3) critical limb ischemia encompassing rest pain, skin necrosis, and gangrene and may include recurrent skin infections; ( 4 ) surgical revasc…”
BackgroundMethodAllison, M. A., Criqui, M. H., McClelland, R. L., Scott, J. M., McDermott, M. M., Liu, K., Folsom, A. R., Bertoni, A. G., Sharrett, A. R., Homma, S., et al. (2006) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2006.05.049 · Cited by 257 · see citing works
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The burden and treatment of diabetes in elderly individuals in the U.S
Selvin, E., Coresh, J., & Brancati, F. L. (2006) · Diabetes Care · doi:10.2337/dc06-1058 · Cited by 261 · see citing works
Self-citationUse and Utility of Ankle Brachial Index in Patients with Diabetes
Potier, L., Khalil, C. A., Mohammedi, K., & Roussel, R. (2010) · European Journal of Vascular and Endovascular Surgery · doi:10.1016/j.ejvs.2010.09.020 · Cited by 252 · see citing works
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Kidney Function and Risk of Peripheral Arterial Disease
Wattanakit, K., Folsom, A. R., Selvin, E., Coresh, J., Hirsch, A. T., & Davison, B. A. (2007) · Journal of the American Society of Nephrology · doi:10.1681/asn.2005111204 · Cited by 247 · see citing works
Self-citationMetals in Urine and Peripheral Arterial Disease
Navas‐Acién, A., Silbergeld, E. K., Sharrett, A. R., Calderon-Aranda, E. S., Selvin, E., & Güallar, E. (2004) · Environmental Health Perspectives · doi:10.1289/ehp.7329 · Cited by 238 · see citing works
“In epidemiologic studies, PAD is usually defined by the presence of a low ( 0.9) blood pressure ankle-brachial index (ABI)—that is, when the systolic blood pressure measured at the ankle is 90% of the systolic blood pressure measured at the arm (Selvin and Erlinger 2004).”
BackgroundInfluentialSelf-citationINDO AMERICAN JOURNAL OF PHARMACEUTICAL SCIENCES
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The Pathway to Foot Ulceration in Diabetes
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“8).(7) In the Fremantle Diabetes Study, a population-based study of peripheral arterial disease in type 2 diabetes in Australia, the reported prevalence for PVD in this population was 13.”
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Long-Term Prognosis of Patients With Peripheral Arterial Disease
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Peripheral Arterial Disease and Risk of Cardiac Death in Type 2 Diabetes
Norman, P. E., Davis, W. A., Bruce, D. G., & Davis, T. M. E. (2006) · Diabetes Care · doi:10.2337/diacare.29.03.06.dc05-1567 · Cited by 220 · see citing works
“Although the prevalence of PAD in diabetic subjects is typically double that seen in nondiabetic individuals (22,23), estimates vary considerably depending on the definition of PAD and the characteristics of the patient sample.”
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Different Calculations of Ankle-Brachial Index and Their Impact on Cardiovascular Risk Prediction
Espinola–Klein, C., Rupprecht, H. J., Bickel, C., Lackner, K. J., Savvidis, S., Messow, C., Münzel, T. F., & Blankenberg, S. (2008) · Circulation · doi:10.1161/circulationaha.107.763227 · Cited by 209 · see citing works
“On the basis of these results, patients were divided into 3 groups (Figure 1): ( 1 ) PAD (n204, 25.0%): ABI 0.9 according to the current definition; (2) no PAD (n524, 64.2%): ABI 0.9 according to the modified definition; and (3) suspected PAD (n88, 10.8%): ABI 0.9 according to the modified definition and ABI 0.9 accor…”
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Lipoprotein(a) and Risk of Coronary, Cerebrovascular, and Peripheral Artery Disease
Gurdasani, D., Sjouke, B., Tsimikas, S., Hovingh, G. K., Luben, R., Wainwright, N. W. J., Pomilla, C., Wareham, N. J., Khaw, K., Boekholdt, S. M., et al. (2012) · Arteriosclerosis Thrombosis and Vascular Biology · doi:10.1161/atvbaha.112.255521 · Cited by 206 · see citing works
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New Directions in Therapeutic Angiogenesis and Arteriogenesis in Peripheral Arterial Disease
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Endothelial HIF-2α regulates murine pathological angiogenesis and revascularization processes
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One-Year Costs in Patients With a History of or at Risk for Atherothrombosis in the United States
Mahoney, E. M., Wang, K., Cohen, D. J., Hirsch, A. T., Alberts, M. J., Eagle, K. A., Mosse, F., Jackson, J. D., Steg, P. G., & Bhatt, D. L. (2008) · Circulation Cardiovascular Quality and Outcomes · doi:10.1161/circoutcomes.108.775247 · Cited by 197 · see citing works
Lower extremity arterial disease in patients with diabetes: a contemporary narrative review
Nativel, M., Potier, L., Alexandre, L., Baillet‐Blanco, L., Ducasse, E., Velho, G., Marre, M., Roussel, R., Rigalleau, V., & Mohammedi, K. (2018) · Cardiovascular Diabetology · doi:10.1186/s12933-018-0781-1 · Cited by 195 · see citing works
Sachs, T. E., Pomposelli, F. B., Hamdan, A. D., Wyers, M. C., & Schermerhorn, M. L. (2011) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2011.03.281 · Cited by 193 · see citing works
Hypercholesterolemia and microvascular dysfunction: interventional strategies
Stapleton, P. A., Goodwill, A. G., James, M. E., Brock, R. W., & Frisbee, J. C. (2010) · Journal of Inflammation · doi:10.1186/1476-9255-7-54 · Cited by 192 · see citing works
“and CAD, considerable attention has been directed toward evaluating the impact and mechanisms of cholesterol lowering therapies and interventions for cardiovascular outcomes [2-4].”
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Diagnosis and management of peripheral arterial disease
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Bisphenol A and Peripheral Arterial Disease: Results from the NHANES
Shankar, A., Teppala, S., & Sabanayagam, C. (2012) · Environmental Health Perspectives · doi:10.1289/ehp.1104114 · Cited by 190 · see citing works
Serum Total Bilirubin Level and Prevalent Lower-Extremity Peripheral Arterial Disease
Perlstein, T. S., Pande, R. L., Beckman, J. A., & Creager, M. A. (2007) · Arteriosclerosis Thrombosis and Vascular Biology · doi:10.1161/atvbaha.107.153262 · Cited by 187 · see citing works
HbA1c and Peripheral Arterial Disease in Diabetes
Selvin, E., Wattanakit, K., Steffes, M. W., Coresh, J., & Sharrett, A. R. (2006) · Diabetes Care · doi:10.2337/diacare.29.04.06.dc05-2018 · Cited by 184 · see citing works
Self-citationThe Association Between Vascular Risk Factors and Lower Urinary Tract Symptoms in Both Sexes
Ponholzer, A., Temml, C., Wehrberger, C., Martin Marszalek, A., & Stephan Madersbacher, A. (2006) · European Urology · doi:10.1016/j.eururo.2006.01.031 · Cited by 182 · see citing works
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A Review of the Pathophysiology and Potential Biomarkers for Peripheral Artery Disease
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Prevalence of Peripheral Arterial Disease – Results of the Heinz Nixdorf Recall Study
Kröger, K., Stang, A., Kondratieva, J., Moebus, S., Beck, E., Schmermund, A., Möhlenkamp, S., Dragano, N., Siegrist, J., Jöckel, K., et al. (2006) · European Journal of Epidemiology · doi:10.1007/s10654-006-0015-9 · Cited by 179 · see citing works
“A total of 90% of these arteries were finally compressible with maximal cuff pressure 25 ].”
BackgroundMethodResultInfluentialVariation in the Use of Lower Extremity Vascular Procedures for Critical Limb Ischemia
Goodney, P. P., Travis, L. L., Nallamothu, B. K., Holman, K. H., Suckow, B. D., Henke, P. K., Lucas, F. L., Goodman, D. C., Birkmeyer, J. D., & Fisher, E. S. (2011) · Circulation Cardiovascular Quality and Outcomes · doi:10.1161/circoutcomes.111.962233 · Cited by 178 · see citing works
Peripheral arterial disease, prevalence and cumulative risk factor profile analysis
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Supervised walking therapy in patients with intermittent claudication
Fakhry, F., van de Luijtgaarden, K. M., Bax, L., den Hoed, P. T., Hunink, M. G. M., Rouwet, E. V., & Spronk, S. (2012) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2012.04.046 · Cited by 172 · see citing works
“Studies were included if they were (1) an RCT comparing SWT and noninterventional observation in patients with IC and (2) assessed PFWD or MWD, or both, or time using a treadmill test before and after SWT.”
MethodSex-Based Differences in Cardiometabolic Biomarkers
Lew, J., Sanghavi, M., Ayers, C. R., McGuire, D. K., Omland, T., Atzler, D., Gore, M. O., Neeland, I. J., Berry, J. D., Khera, A., et al. (2017) · Circulation · doi:10.1161/circulationaha.116.023005 · Cited by 172 · see citing works
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Feringa, H. H. H., van Waning, V. H., Bax, J. J., Elhendy, A., Boersma, E. H., Schouten, O., Galal, W., Vidaković, R., Tangelder, M. J. D., & Poldermans, D. (2006) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2005.09.074 · Cited by 170 · see citing works
- Authors
- Selvin, E., & Erlinger, T. P.
- Affiliations
- Johns Hopkins University (US)
- Venue
- Circulation
- Published
- 2004-08-10
- Volume
- 110
- Issue
- 6
- Pages
- 738-743
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2100049802
- Semantic Scholar
- 086852e793552793c625312acd69ee172fc265e6
- Cited by
- 1,885
- References
- 28
- Citations by year
- 2026: 37 · 2025: 53 · 2024: 78 · 2023: 88 · 2022: 84 · 2021: 67 · 2020: 74 · 2019: 73 · 2018: 90 · 2017: 92 · 2016: 103 · 2015: 112 · 2014: 120 · 2013: 138 · 2012: 139
- FWCI
- 55.28
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Heart, Lung, and Blood Institute (T32 HL 07024, T32HL007024)
- Topics
- Health Sciences › Medicine › Surgery › Peripheral Artery Disease Management
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Vascular Procedures and Complications
- Health Sciences › Medicine › Epidemiology › Healthcare Systems and Public Health
- Keywords
- peripheral arterial disease, prevalence, risk factors, ankle-brachial index, cardiovascular risk factors, smoking, diabetes mellitus, hypertension, hypercholesterolemia, renal function, fibrinogen, C-reactive protein, racial disparities, older adults
- MeSH terms
- Adult, Aged, Aged, 80 and over, Blood Pressure Determination, Brachial Artery, C-Reactive Protein, Cross-Sectional Studies, Diabetes Mellitus, Female, Fibrinogen, Glomerular Filtration Rate, Health Surveys, Humans, Hypercholesterolemia, Hypertension, Kidney Diseases, Male, Middle Aged, Risk Factors, Smoking, United States, Biomarkers, Comorbidity, Prevalence, Peripheral Vascular Diseases, Tibial Arteries, Racial Groups
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