Circulation. 2004;110:738-743
Published online before print July 19, 2004, doi: 10.1161/01.CIR.0000137913.26087.F0
Published online before print July 19, 2004, doi: 10.1161/01.CIR.0000137913.26087.F0
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(Circulation. 2004;110:738-743.)
© 2004 American Heart Association, Inc.
Original Articles |
Prevalence of and Risk Factors for Peripheral Arterial Disease in the United States
Results From the National Health and Nutrition Examination Survey, 1999–2000
From the Department of Epidemiology (E.S., T.P.E.), Johns Hopkins University Bloomberg School of Public Health, and the Department of Medicine (T.P.E.), Welch Center for Prevention, Epidemiology, and Clinical Research (E.S., T.P.E.), Johns Hopkins University, Baltimore, Md.
Correspondence to Thomas P. Erlinger, MD, MPH, Johns Hopkins Medical Institutions, 2024 E Monument St, Suite 2-600, Baltimore, MD 21205. E-mail terlinge{at}jhmi.edu
Received March 15, 2004; revision received May 4, 2004; accepted May 5, 2004.
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.
Key Words: peripheral arterial disease • epidemiology • risk factors
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