Peripheral arterial disease: insights from population studies of older adults

Epidemiologic studies illustrate that PAD is a very common finding when screening is performed in older adults. The outcomes in those with PAD in population studies reflect and extend the findings from clinical studies of PAD, confirming that older adults with PAD are disabled and have a high risk for CVD and total mortality. With the aging of the population, the prevalence of PAD is increasing. It is common in both men and women and increases in prevalence with age, such that at least 12% of community-dwelling adults aged 65 and older will have significant disease on noninvasive testing, most without classic intermittent claudication. Furthermore, PAD is strongly related to other manifestations of CVD and its risk factors. Those with PAD identified in epidemiologic studies have a two- to three-fold risk in CVD morbidity and mortality. Current treatment goals for PAD patients include improving function, primarily using exercise and medical therapy, and reduction of systemic risk and can be extended to those identified by screening. In addition, PAD must be thought of as a marker of advanced systemic atherosclerosis. Inasmuch as the risk of CVD and mortality in those with PAD is similar to those with a history of MI or stroke, those with PAD can be approached with the same measures for secondary CVD prevention as recommended for MI and stroke survivors. A simple bedside measure of the AAI can be used to improve the detection of PAD in clinical practice. Although there is no study that shows directly that screening and preventive treatment will reduce complications of PAD, a preventive approach in PAD patients is likely to improve overall survival, reduce MI, and will, perhaps, also reduce the risk of disabling leg pain and amputation. Future descriptions of the natural history of PAD in ongoing cohort studies may indicate that this is already beginning to occur.