Peripheral artery disease: epidemiology and global perspectives

• Published in: Nature reviews cardiology Vol. 14; no. 3; pp. 156 - 170
• Main Authors: Fowkes, F. Gerry R., Aboyans, Victor, Fowkes, Freya J. I., McDermott, Mary M., Sampson, Uchechukwu K. A., Criqui, Michael H.
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.03.2017; Nature Publishing Group
• Subjects: 692/4019/592/75/593/1920; 692/499; 692/700/1750; 692/700/478/174; 692/700/784; Cardiac Imaging; Cardiac Surgery; Cardiology; Care and treatment; Development and progression; Medicine & Public Health; Peripheral vascular diseases; Prevalence studies (Epidemiology); review-article
• ISSN: 1759-5002; 1759-5010; 1759-5010
• DOI: 10.1038/nrcardio.2016.179

Key Points The ankle–brachial index is the most appropriate measure to use in describing the global distribution of peripheral artery disease (PAD) Worldwide estimates indicate that the greatest numbers of patients with PAD are in Southeast Asia and Western Pacific regions; many individuals are asymptomatic A large proportion of symptomatic patients have atypical leg pain rather than intermittent claudication; patients without pain often have substantial functional impairment Traditional cardiovascular risk factors (smoking, hypertension, diabetes mellitus, and dyslipidaemia) and the ageing of the population are important determinants of PAD in all countries In low-income and middle-income countries especially, environmental factors such as poverty, industrialization, and infection could affect the risk of developing PAD PAD impairs quality of life and is associated with a greatly increased risk of major cardiovascular events and death; PAD is an important cause of amputation worldwide Peripheral artery disease (PAD) is undergoing a major epidemiological transition, with a rapid shift from high-income to low-income and middle-income countries. In this Review, Fowkes et al . describe the measurement of PAD in populations, as well as the worldwide prevalence, risk factors, and burden of the disease. Global populations are undergoing a major epidemiological transition in which the burden of atherosclerotic cardiovascular diseases is shifting rapidly from high-income to low-income and middle-income countries (LMICs). Peripheral artery disease (PAD) is no exception, so that greater focus is now required on the prevention and management of this disease in less-advantaged countries. In this Review, we examine the epidemiology of PAD and, where feasible, take a global perspective. However, the dearth of publications in LMICs means an unavoidable over-reliance on studies in high-income countries. Research to date suggests that PAD might affect a greater proportion of women than men in LMICs. Although factors such as poverty, industrialization, and infection might conceivably influence the development of PAD in such settings, the ageing of the population and increase in traditional cardiovascular risk factors, such as smoking, diabetes mellitus, and hypertension, are likely to be the main driving forces.