Peripheral Artery Disease

What Increases Your Risk


There are a number of factors that predispose individuals to development or progression of peripheral artery disease (PAD)—the buildup of cholesterol plaque (otherwise known as atherosclerosis) in the arteries.

Here's more information about some common risk factors. 

Older age: The chances of getting PAD increase significantly after age 40, and even more so after 70. Almost 1 in 25 people older than 40, 1 in 7 over 70, and 1 in 4 over 80 have PAD.

Smoking: Smoking is the most important modifiable risk factor for the development of PAD. It significantly increases risk of PAD, even more than having coronary artery disease (CAD). A person who smokes can get PAD 10 years earlier than a nonsmoker. Smokers have a risk of PAD that is four times that of nonsmokers. Furthermore, smokers have poorer survival rates and a greater likelihood of developing non-healing wounds, which can develop when stable PAD progresses to critical limb ischemia. Critical limb ischemia is a state where oxygen supply to the leg is inadequate to heal a wound, or prevent new wounds or amputation. Smokers have more re-blockage after arteries are cleaned out, and less success after bypass surgery when compared with nonsmokers.

Diabetes: Diabetes increases the risk of developing PAD by up to four times and leads to an increased risk of cardiovascular events and early death. Almost 30% of PAD patients have diabetes or impaired blood sugar (glucose) tolerance—a precursor to diabetes. Diabetes (and poor foot care) is the most common cause of amputation in the United States. If you have uncontrolled diabetes, it increases your risk for PAD and progression of PAD more than controlled diabetes. Therefore, diabetes control is very important.

Hypertension: High blood pressure is strongly associated with development of atherosclerosis in general, and PAD in particular. As many as 90% of patients with PAD have hypertension.

Dyslipidemia/abnormal cholesterol: In the Framingham Study, an elevated cholesterol level was associated with twice the risk for chronic leg pain. According to the Centers for Disease Control and Prevention’s National Health and Nutrition Examination Survey (NHANES), more than 60% of patients with PAD had hyperlipidemia. Meanwhile, the PARTNERS (PAD Awareness, Risk, and Treatment: New Resources for Survival) program found that three quarters of patients with PAD had high cholesterol levels. The higher the cholesterol level, the higher the risk of developing PAD and coronary artery disease. Treating high cholesterol may reduce risk for PAD progression.

Ethnicity: African Americans and Hispanic females have higher prevalence of PAD than their Caucasian counterparts.

Family history: Family history of premature atherosclerosis in first degree relatives is also a risk factor for PAD.

Metabolic syndrome: Metabolic syndrome (the combination of obesity, high cholesterol, high blood pressure, and high blood sugar) increases the risk for PAD, as it does for coronary artery disease.

Other risk factors: Chronic kidney disease and high levels of certain blood markers of inflammation (C-reactive protein, Beta-2 microglobulin, cystatin C, lipoprotein(a) and homocysteine) have also been associated with increased risk of PAD.

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Published: November 2015
Medical Contributors & Reviewers: Mirvat Alasnag, MD, BCh, King Fahd Armed Forces Hospital; Anne Albers, MD, FACC, Ohio Health; Herbert Aronow, MD, MPH, FACC, Brown University; Wobo Bekwelem, MD, University of Minnesota Hospital & Clinics; Neal Bhatia, MD, Emory University School of Medicine; Jaafer Golzar, MD, FACC, Advocated Christ Medical Center; Keyur Mavani, MD, Community Medical Center and Moses Taylor Hospital; Khusrow Niazi, MBBS, FACC, Emory University; Andrew Roy, MD, ICPS; Michelle Sloan, NP, Eastlake Cardiovascular Associates; Suthipong Soontrapa, MD, Texas Tech University.

Infographic: Peripheral Artery Disease

Walking & PAD

A walking program can be beneficial for patients with peripheral artery disease. Learn more »

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