Epidemiology of peripheral arterial disease

With the aging of the population of most developing nations, arteriosclerosis is becoming a major health problem. Although much research has concentrated on the coronary and cerebral forms of the disease, peripheral arterial disease has received little attention from epidemiologists. The "Rose questionnaire" has been used extensively to diagnose intermittent claudication; however, the current method of choice for the diagnosis of peripheral arterial disease in epidemiologic studies is the ankle brachial pressure index. The prevalence of intermittent claudication, diagnosed by the Rose questionnaire, differs according to age, sex, and geographical location varying between 0.4 and 14.4%; similar variability (from 4.2 to 35%) is seen for disease diagnosed by the ankle brachial pressure index. The major risk factor for peripheral arterial disease is cigarette smoking; hypertension and diabetes have been identified as risk factors in a number of studies; impaired glucose metabolism, dislipidemia, degree of physical activity, and coagulation factors have been identified in some populations. The coexistence of cardiocerebrovascular and peripheral vascular diseases enhances the risk of early death, which is more than double that in the general population: The most frequent cause of death is myocardial infarction. More work is required to document the natural history of the disease, the risk factors for its progression, its relationship with cardiovascular disease, and the effect of intervention strategies.