Peripheral arterial disease epidemiology and demographics: Difference between revisions

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{{Peripheral arterial disease}}
{{Peripheral arterial disease}}


'''Editors-in-Chief: [[C. Michael Gibson]], M.D., Beth Israel Deaconess Medical Center, Boston, MA; [[User:Bobby Schwartz|Robert G. Schwartz, M.D.]] [mailto:RGSHEAL@aol.com], [http://www.piedmontpmr.com Piedmont Physical Medicine and Rehabilitation, P.A.]; '''Associate Editor-In-Chief:''' {{CZ}}
'''Editors-in-Chief:''' [[C. Michael Gibson]]; '''Associate Editor-In-Chief:''' {{CZ}}; [[User:Rim Halaby|Rim Halaby]]


==Overview==
==Overview==
The prevalence of [[peripheral arterial disease]] varies considerably depending on the definition of PAD as well as on the age of the studied population. The overall prevalence of peripheral arterial disease in the general population is 12–14%. The prevalence of PAD is higher in the elderly and affects up to 20% of patients over  the age of 70 years.


== Epidemiology and Demographics ==
==Epidemiology and Demographics==
 
*The overall prevalence of peripheral vascular disease in the general population is 12–14%, affecting up to 20% of those over 70.<ref name="pmid=17580733>{{cite journal |author=Shammas NW |title=Epidemiology, classification, and modifiable risk factors of peripheral arterial disease |journal=[[Vascular Health and Risk Management]] |volume=3 |issue=2 |pages=229–34 |year=2007 |pmid=17580733 |pmc=1994028 |doi= |url=}}</ref><ref name="pmid22572416">{{cite journal| author=Sarangi S, Srikant B, Rao DV, Joshi L, Usha G| title=Correlation between peripheral arterial disease and coronary artery disease using ankle brachial index-a study in Indian population. | journal=Indian Heart J | year= 2012 | volume= 64 | issue= 1 | pages= 2-6 | pmid=22572416 | doi=10.1016/S0019-4832(12)60002-9 | pmc=3860717 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22572416  }} </ref>
*Lower Extremity PAD - Prevalence
* The incidence of symptomatic disease increases with age. It starts at about 0.3% per year for men aged 40–55 years and some studies have shown it to rise to about 1% per year for male patients aolder than 75 years.<ref name="3rx">{{cite web | author =  | title =Peripheral arterial disease prevention and prevalence | work =Peripheral Arterial Disease  | url=http://www.3-rx.com/ab/more/peripheral-arterial-disease-prevention-and-prevalence/ | year = 2007 | month= Nov 1 | publsiher=Your Health Encyclopedia | accessdate=2007-12-03}}</ref><ref name="pmid15287833">{{cite journal| author=Norman PE, Eikelboom JW, Hankey GJ| title=Peripheral arterial disease: prognostic significance and prevention of atherothrombotic complications. | journal=Med J Aust | year= 2004 | volume= 181 | issue= 3 | pages= 150-4 | pmid=15287833 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15287833  }} </ref>
**Affects a large proportion of most adult populations worldwide
* 70%–80% of the patients are asymptomatic and very few patients will ever require revascularisation or amputation.  
**Increases with age and with exposure to atherosclerotic risk factors.
* Peripheral vascular disease affects 1 in 3 diabetics older than 50.<ref name="pmid26185603">{{cite journal| author=Thiruvoipati T, Kielhorn CE, Armstrong EJ| title=Peripheral artery disease in patients with diabetes: Epidemiology, mechanisms, and outcomes. | journal=World J Diabetes | year= 2015 | volume= 6 | issue= 7 | pages= 961-9 | pmid=26185603 | doi=10.4239/wjd.v6.i7.961 | pmc=4499529 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26185603  }} </ref>
**Defined  by:
* Approximately 6.5 million people in America have PVD.<ref name="pmid31992061">{{cite journal| author=Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP | display-authors=etal| title=Heart Disease and Stroke Statistics-2020 Update: A Report From the American Heart Association. | journal=Circulation | year= 2020 | volume= 141 | issue= 9 | pages= e139-e596 | pmid=31992061 | doi=10.1161/CIR.0000000000000757 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31992061  }} </ref> Despite its prevalence and cardiovascular risk implications, only 25 percent of PAD patients are undergoing treatment.<ref name="pmid19008688">{{cite journal| author=Gardner AW, Afaq A| title=Management of lower extremity peripheral arterial disease. | journal=J Cardiopulm Rehabil Prev | year= 2008 | volume= 28 | issue= 6 | pages= 349-57 | pmid=19008688 | doi=10.1097/HCR.0b013e31818c3b96 | pmc=2743684 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19008688  }} </ref>
***[[Claudication]] as a symptomatic marker 
***Abnormal ankle-to brachial systolic blood pressure index ([[Ankle-Brachial Index]] or [[ABI]])
***Underlying atherosclerosis risk factor profile
***Presence of other concomitant manifestations of atherosclerosis
 
===Prevalence and Incidence===
The prevalence of peripheral vascular disease in people aged over 55 years is 10%–25% and increases with age; 70%–80% of affected individuals are asymptomatic; only a minority ever require revascularisation or amputation.<ref name=3rx>{{cite web | author =  | title =Peripheral arterial disease prevention and prevalence | work =Peripheral Arterial Disease  | url=http://www.3-rx.com/ab/more/peripheral-arterial-disease-prevention-and-prevalence/ | year = 2007 | month= Nov 1 | publsiher=Your Health Encyclopedia | accessdate=2007-12-03}}</ref>
 
In the USA peripheral arterial disease affects 12-20 percent of Americans age 65 and older. Despite its prevalence and cardiovascular risk implications, only 25 percent of PAD patients are undergoing treatment.<ref name=health.am>{{cite web | author = A. Richey Sharrett, MD, DRPH  | title =Peripheral arterial disease prevalence| work =Peripheral Arterial Disease | url=http://www.health.am/vein/more/peripheral-arterial-disease-prevalence/ | year = 2007 | month= Sep 21 | publsiher=Armenian Health Network, Health.am | accessdate=2007-12-03}}</ref>
 
The incidence of symptomatic PVD increases with age, from about 0.3% per year for men aged 40–55 years to about 1% per year for men aged over 75 years. The prevalence of PVD varies considerably depending on how PAD is defined, and the age of the population being studied.<ref name="3rx" /> Diagnosis is critical, as people with PAD have a four to five times higher risk of [[Myocardial infarction|heart attack]] or [[stroke]].
 
In Western Australia, the prevalence of symptomatic disease at around 60 years of age is about 5%.<ref name=ncbi>{{cite web | author = Hiatt W, Hoag S, Hamman R.  | title =Effect of diagnostic criteria on the prevalence of peripheral arterial disease | work =Effect of diagnostic criteria on the prevalence of peripheral arterial disease | url=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7867189&dopt=Abstract | year = 1995 | month= Sep 21 | publsiher=Circulation 1995; 91: 1472-1479 | accessdate=2007-12-03}}</ref>
 
A study from the NHANES 1999–2000 data found that PVD affects approximately 5 million adults.<ref name="health.am" />
 
The Diabetes Control and Complications Trial and U.K. Prospective Diabetes Study trials in people with type 1 and type 2 diabetes, respectively, demonstrated that glycemic control is more strongly associated with microvascular disease than macrovascular disease. It may be that pathologic changes occurring in small vessels are more sensitive to chronically elevated glucose levels than is atherosclerosis occurring in larger arteries.<ref name=diabetesjournals>{{cite web | author = Elizabeth Selvin, PHD, MPH, Keattiyoat Wattanakit, MD, MPH, Michael W. Steffes, MD, PHD, Josef Coresh, MD, PHD and A. Richey Sharrett, MD, DRPH  | title =HbA1c and Peripheral Arterial Disease in Diabetes | work =The Atherosclerosis Risk in Communities study | url=http://care.diabetesjournals.org/cgi/content/full/29/4/877 | year = 2005 | month= Oct 20 | publsiher=Diabetes Care | accessdate=2007-12-03}}</ref>
 
If all cases of symptomatic leg pain that have a peripheral arterial disease aspect to it are considered then the incidence of peripheral arterial disease is much higher then cited above. Numerous studies have shown hardening of the arteries in teenagers and a large percentage of  patients with vascular risk factors will have at least early changes if investigated. When ever a patient has vascular risk factors and presents with a condition that includes chronic or complex leg pain (restless legs, sciatica, limb swelling) functional studies such as exercise or stress plethysmography should be considered as part of the diagnosis and treatment protocol [http://wehelpwhathurts.homestead.com/pad.html].


==References==
==References==

Latest revision as of 19:17, 6 October 2020

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AHA/ACC Guidelines on Management of Lower Extremity PAD

Guidelines for Clinical Assessment of Lower Extremity PAD

Guidelines for Diagnostic Testing for suspected PAD

Guidelines for Screening for Atherosclerotic Disease in Other Vascular Beds in patients with Lower Extremity PAD

Guidelines for Medical Therapy for Lower Extremity PAD

Guidelines for Structured Exercise Therapy for Lower Extremity PAD

Guidelines for Minimizing Tissue Loss in Lower Extremity PAD

Guidelines for Revascularization of Claudication in Lower Extremity PAD

Guidelines for Management of CLI in Lower Extremity PAD

Guidelines for Management of Acute Limb Ischemial in Lower Extremity PAD

Guidelines for Longitudinal Follow-up for Lower Extremity PAD

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Editors-in-Chief: C. Michael Gibson; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [1]; Rim Halaby

Overview

The prevalence of peripheral arterial disease varies considerably depending on the definition of PAD as well as on the age of the studied population. The overall prevalence of peripheral arterial disease in the general population is 12–14%. The prevalence of PAD is higher in the elderly and affects up to 20% of patients over the age of 70 years.

Epidemiology and Demographics

  • The overall prevalence of peripheral vascular disease in the general population is 12–14%, affecting up to 20% of those over 70.[1][2]
  • The incidence of symptomatic disease increases with age. It starts at about 0.3% per year for men aged 40–55 years and some studies have shown it to rise to about 1% per year for male patients aolder than 75 years.[3][4]
  • 70%–80% of the patients are asymptomatic and very few patients will ever require revascularisation or amputation.
  • Peripheral vascular disease affects 1 in 3 diabetics older than 50.[5]
  • Approximately 6.5 million people in America have PVD.[6] Despite its prevalence and cardiovascular risk implications, only 25 percent of PAD patients are undergoing treatment.[7]

References

  1. Shammas NW (2007). "Epidemiology, classification, and modifiable risk factors of peripheral arterial disease". Vascular Health and Risk Management. 3 (2): 229–34. PMC 1994028. PMID 17580733.
  2. Sarangi S, Srikant B, Rao DV, Joshi L, Usha G (2012). "Correlation between peripheral arterial disease and coronary artery disease using ankle brachial index-a study in Indian population". Indian Heart J. 64 (1): 2–6. doi:10.1016/S0019-4832(12)60002-9. PMC 3860717. PMID 22572416.
  3. "Peripheral arterial disease prevention and prevalence". Peripheral Arterial Disease. 2007. Retrieved 2007-12-03. Unknown parameter |publsiher= ignored (|publisher= suggested) (help); Unknown parameter |month= ignored (help)
  4. Norman PE, Eikelboom JW, Hankey GJ (2004). "Peripheral arterial disease: prognostic significance and prevention of atherothrombotic complications". Med J Aust. 181 (3): 150–4. PMID 15287833.
  5. Thiruvoipati T, Kielhorn CE, Armstrong EJ (2015). "Peripheral artery disease in patients with diabetes: Epidemiology, mechanisms, and outcomes". World J Diabetes. 6 (7): 961–9. doi:10.4239/wjd.v6.i7.961. PMC 4499529. PMID 26185603.
  6. Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP; et al. (2020). "Heart Disease and Stroke Statistics-2020 Update: A Report From the American Heart Association". Circulation. 141 (9): e139–e596. doi:10.1161/CIR.0000000000000757. PMID 31992061.
  7. Gardner AW, Afaq A (2008). "Management of lower extremity peripheral arterial disease". J Cardiopulm Rehabil Prev. 28 (6): 349–57. doi:10.1097/HCR.0b013e31818c3b96. PMC 2743684. PMID 19008688.


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