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Circulation. 2004;110:738-743
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

Elizabeth Selvin, MPH; Thomas P. Erlinger, MD, MPH

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 {approx}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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Am J EpidemiolHome page
J. M. Murabito, C.-Y. Guo, C. S. Fox, and R. B. D'Agostino
Heritability of the Ankle-Brachial Index: The Framingham Offspring Study
Am. J. Epidemiol., November 15, 2006; 164(10): 963 - 968.
[Abstract] [Full Text] [PDF]


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Diabetes CareHome page
E. Selvin, J. Coresh, and F. L. Brancati
The burden and treatment of diabetes in elderly individuals in the u.s.
Diabetes Care, November 1, 2006; 29(11): 2415 - 2419.
[Abstract] [Full Text] [PDF]


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CirculationHome page
S. Rajagopalan, S. Dellegrottaglie, A. L. Furniss, B. W. Gillespie, S. Satayathum, N. Lameire, A. Saito, T. Akiba, M. Jadoul, N. Ginsberg, et al.
Peripheral Arterial Disease in Patients With End-Stage Renal Disease: Observations From the Dialysis Outcomes and Practice Patterns Study (DOPPS)
Circulation, October 31, 2006; 114(18): 1914 - 1922.
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J Am Coll CardiolHome page
M. A. Allison, M. H. Criqui, R. L. McClelland, J. M. Scott, M. M. McDermott, K. Liu, A. R. Folsom, A. G. Bertoni, A. R. Sharrett, S. Homma, et al.
The Effect of Novel Cardiovascular Risk Factors on the Ethnic-Specific Odds for Peripheral Arterial Disease in the Multi-Ethnic Study of Atherosclerosis (MESA)
J. Am. Coll. Cardiol., September 19, 2006; 48(6): 1190 - 1197.
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CirculationHome page
J. A. Beckman, M. R. Jaff, and M. A. Creager
The United States Preventive Services Task Force Recommendation Statement on Screening for Peripheral Arterial Disease: More Harm Than Benefit?
Circulation, August 22, 2006; 114(8): 861 - 866.
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CirculationHome page
H.-P. Ledermann, A.-C. Schulte, H.-G. Heidecker, M. Aschwanden, K. A. Jager, K. Scheffler, W. Steinbrich, and D. Bilecen
Blood Oxygenation Level-Dependent Magnetic Resonance Imaging of the Skeletal Muscle in Patients With Peripheral Arterial Occlusive Disease
Circulation, June 27, 2006; 113(25): 2929 - 2935.
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Am J EpidemiolHome page
E. Guallar, E. K. Silbergeld, A. Navas-Acien, S. Malhotra, B. C. Astor, A. R. Sharrett, and B. S. Schwartz
Confounding of the Relation between Homocysteine and Peripheral Arterial Disease by Lead, Cadmium, and Renal Function
Am. J. Epidemiol., April 15, 2006; 163(8): 700 - 708.
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Diabetes CareHome page
E. Selvin, K. Wattanakit, M. W. Steffes, J. Coresh, and A. R. Sharrett
HbA1c and Peripheral Arterial Disease in Diabetes: The Atherosclerosis Risk in Communities study
Diabetes Care, April 1, 2006; 29(4): 877 - 882.
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J Am Coll CardiolHome page
H. H.H. Feringa, V. H. van Waning, J. J. Bax, A. Elhendy, E. Boersma, O. Schouten, W. Galal, R. V. Vidakovic, M. J. Tangelder, and D. Poldermans
Cardioprotective Medication Is Associated With Improved Survival in Patients With Peripheral Arterial Disease
J. Am. Coll. Cardiol., March 21, 2006; 47(6): 1182 - 1187.
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Arch Intern MedHome page
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.
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Am J EpidemiolHome page
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.
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CirculationHome page
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.
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Vasc MedHome page
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.
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Vasc MedHome page
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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JAMAHome page
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.
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Eur Heart JHome page
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.
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Arch SurgHome page
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.
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Arch SurgHome page
G. C. Hunter
Clinical Indicators and Psychosocial Aspects in Peripheral Arterial Disease--Invited Critique
Arch Surg, February 1, 2006; 141(2): 166 - 166.
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ANN INTERN MEDHome page
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.
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HypertensionHome page
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.
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CirculationHome page
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.
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Am J EpidemiolHome page
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.
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Arterioscler. Thromb. Vasc. Bio.Home page
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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Vasc MedHome page
J. W Olin
Masterclass series in peripheral arterial disease: Hypertension and peripheral arterial disease
Vascular Medicine, August 1, 2005; 10(3): 241 - 246.
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Diabetes CareHome page
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.
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Am J EpidemiolHome page
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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PERSPECT VASC SURG ENDOVASC THERHome page
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]