Abstract 02: Lifetime Risk of Lower Extremity Peripheral Artery Disease in the US
Background: Prevalence provides information about the burden of disease in the population but does not capture individuals’ risk over time. In contrast, lifetime risk is a useful measure of long-term disease incidence in an individual and is underscored for coronary disease and stroke in the AHA/ACC 2013 guidelines. However, there are no available estimates of lifetime risk of lower extremity peripheral artery disease (PAD), despite its impact on prognosis, leg amputation, and physical function.
Methods: With an established method for lifetime risk estimation used in other fields (e.g., kidney disease), we estimated national average probability of developing PAD, defined as an ankle-brachial index (ABI) <0.9, at each single year of age from birth to 80 years for black/white women and men based on the prevalence of PAD and relative mortality risk related to PAD from the National Health and Nutrition Examination Surveys and overall mortality rate from US National Vital Statistics. Then, Markov chain Monte Carlo simulations in a simulated cohort of 100,000 individuals were implemented to estimate lifetime risk of PAD.
Results: In an 80-year horizon, lifetime risk of PAD was similar between sexes but 1.5-fold higher in blacks compared to whites (35.6% for black women, 30.6% for black men, 22.5% for white women, and 19.4% for white men) (Figure). From another perspective, 10% of blacks and whites develop PAD by the age of 60 years and 70 years, respectively. The remaining lifetime risk at ages of 65 (for those free of PAD until this age) through 80 years was 29.6% in black women, 28.0% in black men, 17.9% in white women, and 16.5% in white men.
Conclusion: In the US, 1 in 3 blacks and 1 in 5 whites will experience lower extremity PAD during their life course. This is the first national estimate of lifetime risk for PAD and should help inform risk-centered screening and prevention strategies. Our results suggest that race is a critical factor in PAD risk, a factor not taken into account for ABI screening in the current clinical guidelines.
Author Disclosures: K. Matsushita: None. Y. Sang: None. S. Ballew: None. E.K. Chow: None. M. Grams: None. E. Selvin: None. A.T. Hirsch: None. J. Coresh: None.
This research has received full or partial funding support from the American Heart Association, National Center.
- © 2015 by American Heart Association, Inc.