Peripheral Arterial Disease: A Global Health Issue
Peripheral Arterial Disease (PAD) represents a significant and growing global health concern, characterized by the narrowing of arteries that supply blood to the limbs, most commonly the legs. This condition, primarily caused by atherosclerosis, leads to reduced blood flow, resulting in symptoms ranging from claudication to critical limb ischemia, and significantly impacts patients' quality of life and overall health outcomes. Despite its substantial prevalence and association with severe adverse events, PAD often remains underdiagnosed and undertreated globally [1].
Global Prevalence and Burden
The global burden of PAD is considerable and continues to pose a challenge to healthcare systems worldwide. In 2021, the worldwide number of PAD cases was estimated at 113.7 million, with an age-standardized prevalence rate of 1326.5 per 100,000 person-years [2]. While the age-standardized prevalence rate showed a decrease of 12.3% from 1990 to 2021, the absolute number of cases remains high, indicating a persistent public health challenge [2]. Projections suggest that the global disability-adjusted life years (DALYs) due to PAD could reach 3.4 million by 2050, underscoring the long-term impact of the disease [2].
PAD disproportionately affects older adults and females, with prevalence increasing significantly with age. For instance, in 2021, the global prevalence counts of PAD reached their highest levels among older adults aged 70–74 years [2]. Furthermore, studies indicate that certain demographic groups, particularly Black American patients, experience a disproportionately higher prevalence and clinical effect of PAD [1]. This highlights the complex interplay of biological, social, and systemic factors contributing to health disparities in PAD. The societal and economic consequences of PAD are also substantial, including higher rates of individual disability, depression, and minor and major limb amputations, alongside increased risks of cardiovascular and cerebrovascular events [1]. These outcomes place a considerable burden on healthcare resources and diminish the overall productivity and well-being of affected populations.
Key Risk Factors
The development and progression of PAD are strongly linked to several modifiable and non-modifiable risk factors. Behavioral and metabolic risks play a critical role in PAD development [2]. Key modifiable risk factors include smoking, diabetes, hypertension, and dyslipidemia [1]. High fasting plasma glucose has also been identified as a significant risk factor [2]. The burden associated with PAD is primarily driven by these modifiable factors, emphasizing the potential for preventive strategies and lifestyle interventions to mitigate the disease's impact [1]. Other contributing factors include chronic kidney disease and advanced age, which are non-modifiable but necessitate heightened screening and management efforts. The interplay of these risk factors often exacerbates the disease's severity and progression, leading to more complex clinical presentations and poorer outcomes.
Impact and Complications
The impact of PAD extends beyond limb-specific symptoms. Atherosclerosis, the underlying cause of PAD, is a systemic inflammatory process, meaning individuals with PAD often have concomitant cardiovascular and cerebrovascular diseases [1]. This systemic nature increases the risk of myocardial infarction, stroke, and other cardiovascular events, contributing to higher rates of morbidity and mortality. In patients with PAD, limb symptoms can severely reduce quality of life, and the devastating outcome of limb amputation imposes significant social and economic burdens on patients and their families [1]. The risk of amputation is particularly elevated in patients with diabetes and PAD, especially among certain racial and ethnic groups who face additional disparities in healthcare access and quality [1].
Addressing the Global Challenge
Appropriate identification and timely initiation of guideline-directed medical therapy are crucial for secondary prevention of cardiovascular disease, cerebrovascular disease, and limb events in PAD patients [1]. Effective management strategies include aggressive risk factor modification, such as smoking cessation, strict glycemic control for diabetics, blood pressure management, and lipid-lowering therapies. Furthermore, supervised exercise programs and pharmacotherapy can improve walking ability and reduce symptoms. Addressing the global burden of PAD requires increased awareness among both the public and healthcare professionals, targeted screening programs for high-risk individuals, and comprehensive management strategies that consider both individual risk factors and broader social determinants of health. Efforts to improve access to specialized care, particularly in underserved communities, are vital to reduce disparities in outcomes and enhance limb preservation. Advances in mobile health and remote patient monitoring also hold promise for expanding access to care and improving long-term outcomes, especially in managing diabetic foot complications associated with PAD [1]. By implementing multifaceted approaches, the global health community can work towards mitigating the devastating effects of PAD and improving the lives of millions worldwide.
References
[1] American Heart Association. Health Disparities in Peripheral Artery Disease: A Scientific Statement From the American Heart Association. *Circulation*. 2023;148(3):286-296. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001153 [2] Fu, M., & Zhang, H. Global burden of peripheral arterial disease and its risk factors, 1990–2021. *BMC Cardiovasc Disord*. 2025;25:631. https://pmc.ncbi.nlm.nih.gov/articles/PMC12379400/