Lifetime Risk of Lower-Extremity Peripheral Artery Disease Defined by Ankle-Brachial Index in the United States

J Am Heart Assoc. 2019 Sep 17;8(18):e012177. doi: 10.1161/JAHA.119.012177. Epub 2019 Sep 10.


Background There are no available lifetime risk estimates of lower-extremity peripheral artery disease (PAD). Methods and Results Using data from 6 US community-based cohorts and the vital statistics, we estimated the prevalence and incidence of PAD, defined as an ankle-brachial index < 0.90, at each year of age from birth to 80 years for white, black, and Hispanic men and women. Then, we used Markov Monte Carlo simulations in a simulated cohort of 100 000 individuals to estimate lifetime risk of PAD. On the basis of odds ratios of PAD for traditional atherosclerotic risk factors (eg, diabetes mellitus and smoking), we developed a calculator providing residual lifetime risk of PAD. In an 80-year horizon, lifetime risks of PAD were 30.0% in black men and 27.6% in black women, but ≈19% in white men and women and ≈22% in Hispanic men and women. From another perspective, 9% of blacks were estimated to develop PAD by 60 years of age, while the same proportion was seen at ≈70 years for whites and Hispanics. The residual lifetime risk within the same race/ethnicity varied by 3.5- to 5-fold according to risk factors (eg, residual lifetime risk in 45-year-old black men was 19.9% when current smoking, diabetes mellitus, and history of cardiovascular disease were absent versus 70.4% when all were present). Conclusions In the United States, ≈30% of blacks are estimated to develop PAD during their lifetime, whereas the corresponding estimate is ≈20% for whites and Hispanics. The residual lifetime risk within the same race/ethnicity substantially varies according to traditional risk factors.

Keywords: epidemiology; peripheral artery disease; risk factor; risk score.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Ankle Brachial Index*
  • Black or African American / statistics & numerical data
  • Child
  • Child, Preschool
  • Diabetes Mellitus / epidemiology
  • Female
  • Hispanic or Latino / statistics & numerical data
  • Humans
  • Incidence
  • Infant
  • Lower Extremity / blood supply*
  • Male
  • Middle Aged
  • Peripheral Arterial Disease / epidemiology*
  • Peripheral Arterial Disease / ethnology
  • Prevalence
  • Smoking / epidemiology
  • United States / epidemiology
  • White People / statistics & numerical data
  • Young Adult