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(Circulation. 2004;110:738-743.)
© 2004 American Heart Association, Inc.
Original Articles |
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 19992000 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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Circulation 2004 110: 643.
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H. H. H. Feringa, J. J. J. Bax, V. H. van Waning, E. Boersma, A. Elhendy, O. Schouten, M. J. Tangelder, M. H. R. M. van Sambeek, A. H. van den Meiracker, and D. Poldermans The Long-term Prognostic Value of the Resting and Postexercise Ankle-Brachial Index. Arch Intern Med, March 13, 2006; 166(5): 529 - 535. [Abstract] [Full Text] [PDF] |
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I. Tzoulaki, G. D. Murray, J. F. Price, F. B. Smith, A. J. Lee, A. Rumley, G. D. O. Lowe, and F. G. R. Fowkes Hemostatic Factors, Inflammatory Markers, and Progressive Peripheral Atherosclerosis: The Edinburgh Artery Study Am. J. Epidemiol., February 15, 2006; 163(4): 334 - 341. [Abstract] [Full Text] [PDF] |
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T. Thom, N. Haase, W. Rosamond, V. J. Howard, J. Rumsfeld, T. Manolio, Z.-J. Zheng, K. Flegal, C. O'Donnell, S. Kittner, et al. Heart Disease and Stroke Statistics--2006 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee Circulation, February 14, 2006; 113(6): e85 - e151. [Full Text] [PDF] |
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M Nylaende, A Kroese, E Stranden, B Morken, G Sandbaek, A. Lindahl, H Arnesen, and I Seljeflot Markers of vascular inflammation are associated with the extent of atherosclerosis assessed as angiographic score and treadmill walking distances in patients with peripheral arterial occlusive disease Vascular Medicine, February 1, 2006; 11(1): 21 - 28. [Abstract] [PDF] |
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R. Stein, I. Hriljac, J. L Halperin, S. M Gustavson, V. Teodorescu, and J. W Olin Limitation of the resting ankle-brachial index in symptomatic patients with peripheral arterial disease Vascular Medicine, February 1, 2006; 11(1): 29 - 33. [Abstract] [PDF] |
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N. A. Khan, S. A. Rahim, S. S. Anand, D. L. Simel, and A. Panju Does the Clinical Examination Predict Lower Extremity Peripheral Arterial Disease? JAMA, February 1, 2006; 295(5): 536 - 546. [Abstract] [Full Text] [PDF] |
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N. Eldrup, H. Sillesen, E. Prescott, and B. G. Nordestgaard Ankle brachial index, C-reactive protein, and central augmentation index to identify individuals with severe atherosclerosis Eur. Heart J., February 1, 2006; 27(3): 316 - 322. [Abstract] [Full Text] [PDF] |
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A. E. Aquarius, J. De Vries, D. P. V. B. Henegouwen, and J. F. Hamming Clinical indicators and psychosocial aspects in peripheral arterial disease. Arch Surg, February 1, 2006; 141(2): 161 - 166. [Abstract] [Full Text] [PDF] |
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G. C. Hunter Clinical Indicators and Psychosocial Aspects in Peripheral Arterial Disease--Invited Critique Arch Surg, February 1, 2006; 141(2): 166 - 166. [Full Text] [PDF] |
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M. M. McDermott, K. Liu, L. Ferrucci, M. H. Criqui, P. Greenland, J. M. Guralnik, L. Tian, J. R. Schneider, W. H. Pearce, J. Tan, et al. Physical Performance in Peripheral Arterial Disease: A Slower Rate of Decline in Patients Who Walk More Ann Intern Med, January 3, 2006; 144(1): 10 - 20. [Abstract] [Full Text] [PDF] |
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J. A. Beckman, C. O. Higgins, and M. Gerhard-Herman Automated Oscillometric Determination of the Ankle-Brachial Index Provides Accuracy Necessary for Office Practice Hypertension, January 1, 2006; 47(1): 35 - 38. [Abstract] [Full Text] [PDF] |
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M. H. Criqui, V. Vargas, J. O. Denenberg, E. Ho, M. Allison, R. D. Langer, A. Gamst, W. P. Bundens, and A. Fronek Ethnicity and Peripheral Arterial Disease: The San Diego Population Study Circulation, October 25, 2005; 112(17): 2703 - 2707. [Abstract] [Full Text] [PDF] |
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J. M. Murabito, J. C. Evans, R. B. D'Agostino Sr., P. W. F. Wilson, and W. B. Kannel Temporal Trends in the Incidence of Intermittent Claudication from 1950 to 1999 Am. J. Epidemiol., September 1, 2005; 162(5): 430 - 437. [Abstract] [Full Text] [PDF] |
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K. Nasir, E. Guallar, A. Navas-Acien, M. H. Criqui, and J. A.C. Lima Relationship of Monocyte Count and Peripheral Arterial Disease: Results From the National Health and Nutrition Examination Survey 1999-2002 Arterioscler Thromb Vasc Biol, September 1, 2005; 25(9): 1966 - 1971. [Abstract] [Full Text] [PDF] |
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J. W Olin Masterclass series in peripheral arterial disease: Hypertension and peripheral arterial disease Vascular Medicine, August 1, 2005; 10(3): 241 - 246. [PDF] |
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P. Muntner, R. P. Wildman, K. Reynolds, K. B. DeSalvo, J. Chen, and V. Fonseca Relationship Between HbA1c Level and Peripheral Arterial Disease Diabetes Care, August 1, 2005; 28(8): 1981 - 1987. [Abstract] [Full Text] [PDF] |
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M. M. McDermott, K. Liu, M. H. Criqui, K. Ruth, D. Goff, M. F. Saad, C. Wu, S. Homma, and A. R. Sharrett Ankle-Brachial Index and Subclinical Cardiac and Carotid Disease: The Multi-Ethnic Study of Atherosclerosis Am. J. Epidemiol., July 1, 2005; 162(1): 33 - 41. [Abstract] [Full Text] [PDF] |
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K. T. Delis The Case for Intermittent Pneumatic Compression of the Lower Extremity as a Novel Treatment in Arterial Claudication Perspectives in Vascular Surgery and Endovascular Therapy, March 1, 2005; 17(1): 29 - 42. [Abstract] [PDF] |
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