DOC News January 1, 2008
Volume 5 Number 1 p. 7
© 2008 American Diabetes Association
Peripheral Artery Disease on the Rise
Researcher calls on physicians to step up primary care screening
Bridget Murray Law
More older American adults than ever are contracting asymptomatic
peripheral artery disease (PAD). In both symptomatic and asymptomatic forms of
the disease, fatty deposits accumulate in the arteries and restrict blood flow
to the extremities. Asymptomatic PAD prevalence increased significantly during
1999–2004 in people ages 
40, with the biggest jump in those ages
70, according to analyses of National Health and Nutrition Examination
Survey (NHANES) data.
In the asymptomatic form of PAD examined in this research, the disease
onset is silent; people do not experience typical PAD symptoms, such as aching
in the legs, ischemia in the leg muscles, and possibly nonhealing ulcers.
To reach their findings, researchers analyzed data on 5,376 participants,
ages 40, from the 1999–2000, 2001–2002, and 2003–2004
NHANES surveys. The participants had no prior history of cardiovascular
disease. They were diagnosed with PAD if they scored <9 on the
ankle-brachial index, a measure of the ratio of blood pressure in the legs to
that in the arms.
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NATIONAL HEART, LUNG, AND BLOOD INSTITUTE/NATIONAL INSTITUTES OF HEALTH AND
THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
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The researchers also evaluated the sample for associated cardiac risk
factors of diabetes, obesity, hypertension, and smoking.
Results showed a significant rise in PAD prevalence, pegging it at 3.7% in
1999–2000, 4.2% in 2001–2002, and 4.6% in 2003–2004. During
the duration of the study, the researchers also noted a rise in obesity,
smoking, hypertension, and diabetes among participants, particularly in the
latter two time periods (see chart).
Parsing the data further, researchers found that women, not men, accounted
for the growth in prevalence of asymptomatic PAD. Obese women had the highest
rates of the disease.
"This was a representative sample of the U.S. population, and if 6.2%
of U.S. women above 40 have PAD, that's a lot of people, and many of those may
not know that they're at risk," says lead researcher Andrew D. Sumner,
MD, medical director of the Heart Station and cardiac prevention at Lehigh
Valley Hospital in Allentown, Pa. What's more, Sumner predicts disease rates
will continue to rise as the U.S. population grows older and its cardiac risk
factors magnify accordingly.
Sumner isn't sure why women show higher asymptomatic PAD rates than men,
but he suspects their higher obesity rates may play a role. Another theory is
that men may be experiencing a greater increase in symptomatic
PAD—a possibility Sumner hopes to explore in future
research.
Sumner believes his findings indicate a need for greater vigilance in
detecting asymptomatic PAD, which—he notes—significantly increases
people's likelihood of developing or dying from heart disease or stroke. He
calls on physicians to step up primary prevention with ankle-brachial
screening and initiation of lipid- and blood-pressure-lowering therapies as
needed, based on results.
Adding the screening to the primary care checkup wouldn't be difficult, he
says.
"We need to be more diligent in identifying these people so we can
more aggressively address the risk factors," he says. "The
ankle-brachial index is easier to do than carotid intima-media thickness. A
trained medical assistant can do this." 
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