Cited by 1,885Peripheral Artery Disease ManagementVascular Procedures and ComplicationsHealthcare Systems and Public Health

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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

Selvin, Elizabeth, Erlinger, Thomas P.·2004·Circulation

DOI 10.1161/01.cir.0000137913.26087.f0

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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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“4 A randomised controlled feasibility trial of a home-based walking behaviour-change intervention for people with intermittent claudication INTRODUCTION Peripheral arterial disease is a vascular condition characterised by atherosclerotic narrowing or occlusion in the arteries of the lower limb, which affects up to 20%…”
Aortoiliac occlusive disease
Paisley, M. J., Adkar, S. S., Sheehan, B. M., & Stern, J. R. (2022) · Seminars in Vascular Surgery · doi:10.1053/j.semvascsurg.2022.04.005 · Cited by 21
Correlation between Patient-Reported Symptoms and Ankle-Brachial Index after Revascularization for Peripheral Arterial Disease
Je, H. G., Kim, B. H., Cho, K., Jang, J., Park, Y. B., & Spertus, J. A. (2015) · International Journal of Molecular Sciences · doi:10.3390/ijms160511355 · Cited by 20
Intermittent claudication in the Erfurt Male Cohort (ERFORT) Study: its determinants and the impact on mortality. A population-based prospective cohort study with 30 years of follow-up.
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Long-Term Mortality After Invasive Angiography and Endovascular Revascularization in Patients With PAD Having Chronic Kidney Disease
Gebauer, K., Engelbertz, C. M., Malyar, N. M., Meyborg, M., Lüders, F., Freisinger, E., & Reinecke, H. (2015) · Angiology · doi:10.1177/0003319715603184 · Cited by 20
Association between ear creases and peripheral arterial disease
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Self-reported symptoms on questionnaires and anatomic lesions on duplex ultrasound examinations in patients with peripheral arterial disease
van Zitteren, M., Vriens, P. W. H. E., Heyligers, J. M. M., Burger, D. H. C., Nooren, M. J., de Fijter, W. M., Denollet, J., & Smolderen, K. G. E. (2012) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2011.10.115 · Cited by 20
Coexistent Extra- and Intracranial Stenosis, Cervical Atherosclerosis, and Abnormal Ankle Brachial Index in Acute Ischemic Stroke
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Medical therapy for peripheral arterial disease
Simmons, A., Steffen, K. J., & Sanders, S. (2012) · Current Opinion in Cardiology · doi:10.1097/hco.0b013e328357428a · Cited by 20
“The presence of PAD is 20–30% higher in diabetics then in the general population [42,43].”
Background
Intra-Arterial Transplantation of Adult Bone Marrow Cells Restores Blood Flow and Regenerates Skeletal Muscle in Ischemic Limbs
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Bilateral Toe Necrosis Resulting from Norepinephrine Bitartrate Usage
Simman, R., & Phavixay, L. (2013) · Advances in Skin & Wound Care · doi:10.1097/01.asw.0000431083.77517.fd · Cited by 20
“The risk factors that favor the development of PAD include hyperlipidemia, smoking, hypertension, and diabetes and are similar to those that promote the development of coronary atherosclerosis.(10,11) Hypertension and diabetes often coexist in the older adult population.”
Background
Sleep apnoea is common in severe peripheral arterial disease
Schahab, N., Sudan, S., Schaefer, C. A., Tiyerili, V., Steinmetz, M., Nickenig, G., Skowasch, D., & Pizarro, C. (2017) · PLoS ONE · doi:10.1371/journal.pone.0181733 · Cited by 21
Thirty-day readmission and mortality among Medicare beneficiaries discharged to skilled nursing facilities after vascular surgery
Fernandes‐Taylor, S., Berg, S., Gunter, R., Bennett, K. M., Smith, M. A., Rathouz, P. J., Greenberg, C. C., & Kent, K. C. (2017) · Journal of Surgical Research · doi:10.1016/j.jss.2017.08.041 · Cited by 20
Screening for the Presence of Cardiovascular Disease
Poirier, P., Bertrand, O. F., Leipsic, J., Mancini, G. B. J., Raggi, P., & Roussin, A. (2018) · Canadian Journal of Diabetes · doi:10.1016/j.jcjd.2017.10.025 · Cited by 21
Influence of micro- and macro-vascular disease and Tumor Necrosis Factor Receptor 1 on the level of lower-extremity amputation in patients with type 2 diabetes
Schneider, F. M., Saulnier, P., Gand, E., Desvergnes, M., Lefort, N., Thorin, É., Thorin‐Trescases, N., Mohammedi, K., Ragot, S., Ricco, J., et al. (2018) · Cardiovascular Diabetology · doi:10.1186/s12933-018-0725-9 · Cited by 20
PAD in Women: the Ischemic Continuum
Pollak, A. (2015) · Current Atherosclerosis Reports · doi:10.1007/s11883-015-0513-x · Cited by 16
Asymptomatic peripheral arterial disease: is pharmacological prevention of cardiovascular risk cost-effective?
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Effects of Cilostazol and Pentoxifylline on Forearm Reactive Hyperemia Response, Lipid Profile, Oxidative Stress, and Inflammatory Markers in Patients With Intermittent Claudication
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Functional Results After Through-Knee and Above-Knee Amputations: Does More Length Mean Better Outcome?
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Effectiveness of Viabahn in the Treatment of Superficial Femoral Artery Occlusive Disease
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Effectiveness of a Medical vs Revascularization Intervention for Intermittent Leg Claudication Based on Patient-Reported Outcomes
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Hemorrhoid is associated with increased risk of peripheral artery occlusive disease: A nationwide cohort study
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Évaluation de la prévalence et des facteurs de risque de l’artériopathie oblitérante des membres inférieurs dans le cadre d’une campagne de dépistage ambulatoire
Behar, T., Bosson, J., Galanaud, J. ‐., Thoret, S., Rolland, C., Bura-Rivière, A., Quéré, I., & Laroche, J. P. (2013) · Journal des Maladies Vasculaires · doi:10.1016/j.jmv.2012.10.005 · Cited by 19
Understanding Atherosclerosis Through an Osteoarthritis Data Set
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Social Deprivation and Peripheral Artery Disease
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Khoury, R. E., Wu, B., Kupiec-Weglinski, S. A., Liu, I. H., Edwards, C. T., Lancaster, E. M., Hiramoto, J. S., Vartanian, S. M., Schneider, P. A., & Conte, M. S. (2022) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2022.04.042 · Cited by 19
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Critical Limb Ischemia
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Prevalence of Peripheral Arterial Disease among Adult Patients Attending Outpatient Clinic at a General Hospital in South Angola
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“3% of Americans aged 40 years and older [2], reaching 12.”
BackgroundResultInfluential
A risk score assessment tool for peripheral arterial disease in women: From the National Health and Nutrition Examination Survey
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Presurgery exercise-based conditioning interventions (prehabilitation) in adults undergoing lower limb surgery for peripheral arterial disease.
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“Selvin 2004 Selvin E, Erlinger TP. Prevalence of and risk factors for peripheral arterial disease in the United States: results from the National Health and Nutrition Examination Survey, 1999-2000.”
Background
Ischemia-modified albumin and NT-prohormone-brain natriuretic peptide in peripheral arterial disease
Montagnana, M., Lippi, G., Fava, C., Minuz, P., Santonastaso, C. L., Arosio, E., & Guidi, G. C. (2006) · Clinical Chemistry and Laboratory Medicine (CCLM) · doi:10.1515/cclm.2006.038 · Cited by 19

Authors: Selvin, E., & Erlinger, T. P.
Affiliations: Johns Hopkins University (US)
ORCID: Selvin, Elizabeth
Erlinger, Thomas P.
Venue: Circulation
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2004-08-10
Volume: 110
Issue: 6
Pages: 738-743
ISSN: 0009-7322 (ISSN-L)
1524-4539
DOI: 10.1161/01.cir.0000137913.26087.f0
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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Prevalence of and Risk Factors for Peripheral Arterial Disease in the United States: Results From the National Health and Nutrition Examination Survey, 1999–2000

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