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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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Matheny, H. E., Woo, K., Siada, S., Qumsiyeh, Y., Aparicio, C., Borashan, C., & O’Banion, L. A. (2023) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2023.06.001 · Cited by 12
The Indian Consensus Statement for the Management of Lower Extremity Peripheral Artery Disease
Khanna, N. N., Krishna, V. N., Manjunath, C., Tyagi, S., Jindal, R., Chadha, M. D., Natesh, B. H., Warawdekar, G., WANGNOO, S. K., Chopra, H. K., et al. (2023) · Journal of Indian College of Cardiology · doi:10.4103/1561-8811.383634 · Cited by 14
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“0) Data: Selvin and Erlinger (2004).(59) Data: Annual estimates of the resident population by sex and five-year age groups for the United States: April 1, 2000 to July 1, 2009 (NC-EST2009-01) U.”
Jang, J. J., Schwarcz, A. I., Amaez, D. A., Woodward, M., Olin, J. W., Keller, M. J., & Schecter, A. D. (2010) · Journal of the International AIDS Society · doi:10.1186/1758-2652-13-12 · Cited by 12
“The PT-only ABI method was chosen since numerous large PAD epidemiological studies, including National Health and Nutrition Examination Survey (NHANES), used this technique [22-26].”
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Tang, J., Li, T., Li, P., Ma, Y., Liu, M., Shan, Q., Guo, F., Zhou, T., & Wei, Q. (2017) · Ophthalmic Research · doi:10.1159/000479931 · Cited by 12
Effect of Patient Characteristics on Vessel Enhancement at Lower Extremity CT Angiography
Masuda, T., Nakaura, T., Funama, Y., Sato, T., Higaki, T., Kiguchi, M., Yamashita, Y., Imada, N., & Awai, K. (2018) · Korean Journal of Radiology · doi:10.3348/kjr.2018.19.2.265 · Cited by 12
Quiescent-Interval Single-Shot Magnetic Resonance Angiography
Saini, A., Wallace, A., Albadawi, H., Naidu, S., Alzubaidi, S. J., Knuttinen, M. G., Panda, A., & Öklü, R. (2018) · Diagnostics · doi:10.3390/diagnostics8040084 · Cited by 12
“More than 200 million people worldwide are afflicted by peripheral arterial disease (PAD) [1, 2].”
Nwancha, A.-B., Alvarado, E., Ma, J., Gillum, R. F., & Hughes, K. (2020) · Vascular and Endovascular Surgery · doi:10.1177/1538574420928158 · Cited by 12
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“5%, and PAOD can affect up to 20% of individuals older than 75 years [1].”
BackgroundDrug Treatment of Peripheral Arterial Disease in the Elderly
Aronow, W. S. (2006) · Drugs & Aging · doi:10.2165/00002512-200623010-00001 · Cited by 12
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Racial Disparity in Amputation-Free Survival After Infrainguinal Bypass Procedure
Oh‐Park, M., McGinn, A., Lipsitz, E. C., Thomas, M. A., & Zonszein, J. (2009) · American Journal of Physical Medicine & Rehabilitation · doi:10.1097/phm.0b013e3181bc0ae4 · Cited by 12
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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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