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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“Another issue is that the incidence of PAD rapidly increases during the climacteric period and after the fifth decade - it is at least equally frequent in both genders [7].”
Background
Similitudes y diferencias entre los pacientes con aterosclerosis sintomática de distintos territorios. Cohorte AIRVAG (Atención Integral al Riesgo VAscular Global)
Guijarro, C., Mesa, N., Jiménez, J., Puras, E., Sánchez, C., Fernández, J., González‐Anglada, I., Luján, S., Belinchón, J. C., Casas, M. L. M. D. L., et al. (2006) · Medicina Clínica · doi:10.1157/13094417 · Cited by 16
Upper Extremity Computed Tomographic Angiography: State of the Art Technique and Applications in 2010
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High-Permittivity Thin Dielectric Padding Improves Fresh Blood Imaging of Femoral Arteries at 3 T
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Is the ankle-brachial index a useful screening test for subclinical atherosclerosis in asymptomatic, middle-aged adults?
Wyman, R. A., Keevil, J. G., Busse, K. L., Aeschlimann, S. E., Korcarz, C. E., & Stein, J. H. (2006) · PubMed · Cited by 16
Increased Prevalence of Moderate and Severe Peripheral Arterial Disease in the American Indian (AI)/Alaskan Native (AN) Population; a Study of 96,000 AI/AN
Baxter, A. R., Jacobowitz, G. R., Guo, Y., Maldonado, T., Adelman, M. A., Berger, J. S., & Rockman, C. B. (2017) · Annals of Vascular Surgery · doi:10.1016/j.avsg.2016.08.002 · Cited by 15
Peripheral Artery Disease and Non-Coronary Atherosclerosis in Hispanics: Another Paradox?
Forbang, N. I., Hughes-Austin, J. M., Allison, M. A., & Criqui, M. H. (2014) · Progress in Cardiovascular Diseases · doi:10.1016/j.pcad.2014.07.008 · Cited by 13
Management of arterial hypertension in patients with peripheral arterial disease
POREDOŠ, P., Mikhailidis, D. P., Paraskevas, K. I., Blinc, A., Antignani, P. L., Stanek, A., Mansilha, A., & Cevc, M. (2024) · International Angiology · doi:10.23736/s0392-9590.24.05242-8 · Cited by 16
Prevalence and risk factors of peripheral artery disease in a population with chronic kidney disease in Australia: A systematic review and meta‐analysis
Ho, C. L. B., Chih, H., Garimella, P. S., Matsushita, K., Jansen, S. J., & Reid, C. M. (2021) · Nephrology · doi:10.1111/nep.13914 · Cited by 15
D-Dimer Is a Diagnostic Biomarker of Abdominal Aortic Aneurysm in Patients With Peripheral Artery Disease
Cai, H., Pan, B., Xu, J., Liu, S., Wang, L., Wu, K., Yang, P., Huang, J., & Wang, W. (2022) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2022.890228 · Cited by 15
The Association Between Metabolic Dysfunction-Associated Fatty Liver Disease and Peripheral Arterial Disease in the Chinese Population
Song, X., Liu, B., Lei, F., Liu, Y.-M., Zhang, X., Chen, Z., Zhang, P., Zhang, X., She, Z., Cai, J., et al. (2023) · Diabetes Metabolic Syndrome and Obesity · doi:10.2147/dmso.s394414 · Cited by 15
Association of salivary levels of DNA sensing inflammasomes AIM2, IFI16, and cytokine IL18 with periodontitis and diabetes
Arunachalam, L. T., Suresh, S., Lavu, V., Vedamanickam, S., Sathiyapriya, V., & Nathan, R. D. T. (2023) · Journal of Periodontology · doi:10.1002/jper.23-0184 · Cited by 15
Validated spectrofluorimetric and resonance Rayleigh scattering methods for determining naftidrofuryl in varied pharmaceutical samples based on its interaction with erythrosin B
Binkadem, M. S., AlSalem, H. S., Al‐Goul, S. T., Hamd, M. A. E., Oraby, M., Zainy, F. M. A., & Abdel-Lateef, M. A.-K. (2023) · Luminescence · doi:10.1002/bio.4570 · Cited by 15
Risk factors for and risk of all-cause and atherosclerotic cardiovascular disease mortality in people with type 2 diabetes and peripheral artery disease: an observational, register-based cohort study
Avdic, T., Carlsen, H. K., Rawshani, A., Guðbjörnsdóttir, S., Mandalenakis, Z., & Eliasson, B. (2024) · Cardiovascular Diabetology · doi:10.1186/s12933-024-02226-x · Cited by 18
Leriche Syndrome Presenting with Multisystem Vaso-Occlusive Catastrophe
McCoy, E., Patierno, S. R., & Lotfipour, S. (2015) · Western Journal of Emergency Medicine · doi:10.5811/westjem.2015.4.25401 · Cited by 15
The Impact of Peripheral Arterial Disease on Patients with Congestive Heart Failure
Keswani, A. N., & White, C. J. (2014) · Heart Failure Clinics · doi:10.1016/j.hfc.2013.10.006 · Cited by 15
Therapeutic Angiogenesis by Gene Therapy for Critical Limb Ischemia: Choice of Biological Agent
Sanada, F., Taniyama, Y., Azuma, J., Yuka, I.-I., Kanbara, Y., Iwabayashi, M., Rakugi, H., & Morishita, R. (2014) · Immunology Endocrine & Metabolic Agents - Medicinal Chemistry · doi:10.2174/1871522213999131231105139 · Cited by 15
“95% of persons with PAD had one or more cardiovascular disease risk factors [43].”
Peripheral Artery Disease
Kolluri, R., & Jaff, M. R. (2017) · Hospital Medicine Clinics · doi:10.1016/j.ehmc.2017.04.008 · Cited by 17
Critical Appraisal of the Quality of Evidence Addressing the Diagnosis, Prognosis, and Management of Peripheral Artery Disease in Patients With Diabetic Foot Ulceration
Ali, S. R., Ozdemir, B. A., & Hinchliffe, R. J. (2018) · European Journal of Vascular and Endovascular Surgery · doi:10.1016/j.ejvs.2018.05.009 · Cited by 15
Infrared Thermography Follow-Up After Lower Limb Revascularization
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Rationale and design of a smartphone‐enabled , home‐based exercise program in patients with symptomatic peripheral arterial disease: The smart step randomized trial
Harzand, A., Vakili, A. A., Alrohaibani, A., Abdelhamid, S., Gordon, N. F., Thiel, J., Benarroch‐Gampel, J., Teodorescu, V. J., Minton, K., WENGER, N. K., et al. (2020) · Clinical Cardiology · doi:10.1002/clc.23362 · Cited by 14
Identifying peripheral arterial diseases or flow limitations of the lower limb: Important aspects for cardiovascular screening for referral in physiotherapy
Feller, D., Giudice, A. D., Faletra, A., Salomon, M., Galeno, E., Rossettini, G., Brindisino, F., Maselli, F., Hutting, N., & Mourad, F. (2022) · Musculoskeletal Science and Practice · doi:10.1016/j.msksp.2022.102611 · Cited by 15
Management of peripheral arterial disease in the elderly: focus on cilostazol
Norman, P. E. (2008) · Clinical Interventions in Aging · doi:10.2147/cia.s1735 · Cited by 15
“The prevalence of symptomatic and asymptomatic PAD increases markedly with age, smoking, and diabetes (Selvin and Erlinger 2004).”
Influential
Effect of Peripheral Vascular Disease on Mortality in Cardiac Transplant Recipients (from the United Network of Organ Sharing Database)
Enciso, J. S., Kato, T., Jin, Z., Chung, C. J., Yang, J. A., Takayama, H., MANCINI, D. M., & Schulze, P. C. (2014) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2014.07.027 · Cited by 15
Critical Limb Ischemia—Need to Look Beyond Limb Salvage
Kumar, B. N., & Gambhir, R. P. S. (2011) · Annals of Vascular Surgery · doi:10.1016/j.avsg.2011.05.020 · Cited by 15
Cardiovascular Risk Factors and Distributions of the Ankle‐Brachial Index among Type 2 Diabetes Mellitus Patients
Badaruddoza, B., Kaur, M., Chopra, S., & Kapoor, R. (2012) · International Journal of Hypertension · doi:10.1155/2012/485812 · Cited by 15
“It has also been reported [16, 17] that prevalence of peripheral arterial disease is increasing in adults aged >40 years on the basis of mean ankle-brachial index <0.”
Background
Comparison and Evaluation of Cardiac Biomarkers in Patients with Intermittent Claudication: Results from the CAVASIC Study
Kollerits, B., Sturm, G., Lamina, C., Hammerer‐Lercher, A., Rantner, B., Stadler, M., Ziera, T., Struck, J., Klein-Weigel, P. F., Fraedrich, G., et al. (2013) · Clinical Chemistry · doi:10.1373/clinchem.2012.193656 · Cited by 15
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The impact of diabetes on the extent of pial collaterals in acute ischemic stroke patients
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Background
Ankle-Brachial Index as a Predictor of Mortality in Hemodialysis: A 5-Year Cohort Study
Miguel, J. B., de Matos, J. P. S., & Lugon, J. R. (2017) · Arquivos Brasileiros de Cardiologia · doi:10.5935/abc.20170026 · Cited by 15
Close correlation between the ankle-brachial index and symptoms of depression in hemodialysis patients
Jong, I., Tsai, H., Lin, C.-H., Ma, T.-L., Guo, H., Hung, P., & Hung, K. (2017) · International Urology and Nephrology · doi:10.1007/s11255-017-1598-7 · Cited by 15
“Although traditional cardiovascular risk factors such as smoking, diabetes, hypertension, and hyperlipidemia have been proven to be strong risk factors for PAD in the general population [9], depression is associated with PAD in women, and is not unusual in the general population having suffered from PAD, and occurs in…”
Background
Endovascular Treatment for Steno-Occlusive Iliac Artery Disease: Safety and Long-Term Outcome
Müller, A. M., Langwieser, N., Bradaric, C., Haller, B., Fusaro, M., Ott, I., von Beckerath, N., Kastrati, A., Laugwitz, K., & Ibrahim, T. (2017) · Angiology · doi:10.1177/0003319717720052 · Cited by 15
The Pharmacology, Efficacy, and Safety of Rivaroxaban in Obese Patient Populations
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C-reactive protein and subclinical cardiovascular disease among African−Americans
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Substitution of poultry and red meat with fish and the risk of peripheral arterial disease: a Danish cohort study
Lasota, A. N., Grønholdt, M.-L. M., Bork, C. S., Lundbye‐Christensen, S., Schmidt, E. B., & Overvad, K. (2018) · European Journal of Nutrition · doi:10.1007/s00394-018-1822-y · Cited by 14
Nonatherosclerotic PAD: Approach to Exertional Pain in the Lower Extremities
Mintz, A. J., & Weinberg, I. (2015) · Current Cardiology Reports · doi:10.1007/s11886-015-0622-8 · Cited by 12

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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