Epidemiology of Peripheral Artery Disease and Polyvascular Disease

Abstract

Atherosclerotic lower extremity peripheral artery disease (PAD) is increasingly recognized as an important cause of cardiovascular morbidity and mortality that affects >230 million people worldwide. Traditional cardiovascular risk factors, including advanced age, smoking, and diabetes, are strongly linked to an increase risk of PAD. Although PAD has been historically underappreciated compared with coronary artery disease and stroke, greater attention on PAD in recent years has led to important new epidemiological insights in the areas of thrombosis, inflammation, dyslipidemia, and microvascular disease. In addition, the concept of polyvascular disease, or clinically evident atherosclerosis in multiple arterial beds, is increasingly identified as a particularly malignant cardiovascular disease worthy of special clinical attention and further study. It is noteworthy that PAD may increase the risk of adverse outcomes in similar or even greater magnitude than coronary disease or stroke. In this review, we highlight important new advances in the epidemiology of PAD with a particular focus on polyvascular disease, emerging biomarkers, and differential risk pathways for PAD compared with other atherosclerotic diseases.

Keywords: epidemiology; peripheral artery disease; risk factors; smoking; vascular diseases.

Figure 1.. Risk of smoking and persistence of risk after cessation for major atherosclerotic diseases

A – Multivariable adjusted hazard ratios for CAD, stroke, and PAD by pack-years of smoking in the Atherosclerosis Risk in Communities Study. B – Time-varying multivariable adjusted hazard ratios for CAD, stroke, and PAD by time since smoking cessation in the Atherosclerosis Risk in Communities Study. CAD refers to coronary artery disease; PAD, peripheral artery disease; CI, confidence interval Data derived from Ding N, Sang Y, Chen J, Ballew SH, Kalbaugh CA, Salameh MJ, Blaha MJ, Allison M, Heiss G, Selvin E, Coresh J and Matsushita K. Cigarette Smoking, Smoking Cessation, and Long-Term Risk of 3 Major Atherosclerotic Diseases. J Am Coll Cardiol. 2019;74:498–507.

Figure 2.. Adjusted odds ratio of reduced physical function* according to categories of ABI.

* Defined as the Short Physical Performance Battery score ≤5 and adjusted for age, race, sex, education, smoking, alcohol, body mass index, antihypertensive medications, systolic blood pressure, lipids, lipid-lowering medications, history of coronary artery disease, stroke, or heart failure. ABI refers to ankle-brachial index.

Figure 3.. Cardiovascular Risks of Polyvascular Disease

Atherosclerotic disease in a given vascular bed is directly linked to adverse outcomes in that same organ. Because polyvascular disease is indicative of systemic atherosclerosis, individuals with polyvascular disease are at heightened risk for cardiovascular events in all vascular territories. (Illustration credit: Ben Smith).