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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 somewhere between 4 and 10%.[4][5][6]”
From Racial and Ethnic Disparities in Peripheral Artery Disease (2021) · cites this paper as [6]
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“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]
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“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]
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“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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“16,17,56 Furthermore, Tables 1, 2 and 4 show that other methods were also used, which led to different sensitivity and specificity, as well as prevalence of PAD.”
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“. .?”), ( 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?””
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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…”
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“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).”
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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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Menard, M. T., Farber, A. M., Assmann, S. F., Choudhry, N. K., Conte, M. S., Creager, M. A., Dake, M. D., Jaff, M. R., Kaufman, J. A., Powell, R. J., et al. (2016) · Journal of the American Heart Association · doi:10.1161/jaha.116.003219 · Cited by 233
Long-Term Prognosis of Patients With Peripheral Arterial Disease
Welten, G. M. J. M., Schouten, O., Hoeks, S. E., Chonchol, M., Vidaković, R., van Domburg, R. T., Bax, J. J., van Sambeek, M. R. H. M., & Poldermans, D. (2008) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2007.11.077 · Cited by 230
Jaime, J., Migliaccio–Walle, K., Ishak, K. J., & Proskorovsky, I. (2005) · BMC Cardiovascular Disorders · doi:10.1186/1471-2261-5-14 · Cited by 221
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
“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.”
BackgroundGiles, F., Mauro, M., Hong, F., Ortmann, C., Mcneill, C., Woodman, R., Hochhaus, A., Coutre, P. L., & Saglio, G. (2013) · Leukemia · doi:10.1038/leu.2013.69 · Cited by 216
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
“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…”
MethodInfluentialEslami, M. H., Zayaruzny, M., & FitzGerald, G. (2007) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2006.09.044 · Cited by 209
Conte, S. M., & Vale, P. R. (2017) · Heart Lung and Circulation · doi:10.1016/j.hlc.2017.10.014 · Cited by 208
Harwood, A.-E., Smith, G. E., Cayton, T., Broadbent, E., & Chetter, I. C. (2016) · Annals of Vascular Surgery · doi:10.1016/j.avsg.2016.02.009 · Cited by 199
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 207
Hageman, D., Fokkenrood, H. J., Gommans, L. N. M., van den Houten, M. M. L., & Teijink, J. A. W. (2018) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd005263.pub4 · Cited by 206
New Directions in Therapeutic Angiogenesis and Arteriogenesis in Peripheral Arterial Disease
Annex, B. H., & Cooke, J. P. (2021) · Circulation Research · doi:10.1161/circresaha.121.318266 · Cited by 211
Stein, R., Hriljac, I., Halperin, J. L., Gustavson, S. M., Teodorescu, V. J., & Olin, J. W. (2006) · Vascular Medicine · doi:10.1191/1358863x06vm663oa · Cited by 202
Endothelial HIF-2α regulates murine pathological angiogenesis and revascularization processes
Skuli, N., Majmundar, A. J., Krock, B. L., Mesquita, R. C., Mathew, L. K., Quinn, Z. L., Runge, A., Liu, L., Kim, M. N., Liang, J., et al. (2012) · Journal of Clinical Investigation · doi:10.1172/jci57322 · Cited by 209
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
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 207
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
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
“and CAD, considerable attention has been directed toward evaluating the impact and mechanisms of cholesterol lowering therapies and interventions for cardiovascular outcomes [2-4].”
BackgroundWestin, G. G., Armstrong, E. J., Bang, H., Yeo, K.-K., Anderson, D., Dawson, D. L., Pevec, W. C., Amsterdam, E. A., & Laird, J. R. (2014) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2013.09.073 · Cited by 189
Diagnosis and management of peripheral arterial disease
Peach, G., GRIFFIN, M. B., Jones, K. G., THOMPSON, M. M., & Hinchliffe, R. J. (2012) · BMJ · doi:10.1136/bmj.e5208 · Cited by 190
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 194
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
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
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
Aboyans, V., Criqui, M. H., McClelland, R. L., Allison, M., McDermott, M. M., Goff, D. C., & Manolio, T. A. (2007) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2006.10.032 · Cited by 181
Allison, M., Armstrong, D. G., Goodney, P. P., Hamburg, N. M., Kirksey, L., Lancaster, K. J., Mena‐Hurtado, C., Misra, S., Treat‐Jacobson, D., & Solaru, K. W. (2023) · Circulation · doi:10.1161/cir.0000000000001153 · Cited by 187
A Review of the Pathophysiology and Potential Biomarkers for Peripheral Artery Disease
Krishna, S. M., Moxon, J. V., & Golledge, J. (2015) · International Journal of Molecular Sciences · doi:10.3390/ijms160511294 · Cited by 179
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
“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
Peripheral arterial disease, prevalence and cumulative risk factor profile analysis
Eraso, L. H., Fukaya, E., Mohler, E. R., Xie, D., Sha, D., & Berger, J. S. (2012) · European Journal of Preventive Cardiology · doi:10.1177/2047487312452968 · Cited by 180
Olin, J. W., White, C. J., Armstrong, E. J., Kadian‐Dodov, D. L., & Hiatt, W. R. (2016) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2015.12.049 · Cited by 180
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
“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
Ramos, R., Quesada, M., Solanas, P., Subirana, I., Sala, J., Vila, J., Masià, R., Cerezo, C., Elosúa, R., Grau, M., et al. (2009) · European Journal of Vascular and Endovascular Surgery · doi:10.1016/j.ejvs.2009.04.013 · Cited by 170
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 172
Metadata
- 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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