Published in late September, a comprehensive three-part series in The Lancet reveals that peripheral artery disease (PAD) impacts more than 113 million adults aged 40 and older worldwide. Despite a five-year mortality rate reaching up to 50% in advanced stages—exceeding that of some cancers and acute myocardial infarction—PAD remains underrecognized and undertreated globally.
Translating the Global Burden of Peripheral Artery Disease
The spotlight on peripheral artery disease launched on September 22, pulling back the curtain on a silent vascular crisis affecting millions. Christian-Alexander Behrendt, MD, and his colleagues emphasize that PAD can remain asymptomatic for decades. This latency lulls both patients and clinicians into a false sense of security before advanced complications manifest.
When the disease progresses, advanced disease is associated with a five-year mortality of 30-50%. This grim statistic positions severe vascular obstruction as deadlier than some cancers and acute myocardial infarction. The primary drivers behind this escalating prevalence include aging populations, smoking, diabetes and other cardiovascular risk factors.
Furthermore, the data underscores a strong association between PAD and polyvascular disease. Between 46-68% of patients with PAD also exhibit atherosclerotic plaque buildup in other vascular beds. This systemic distribution increases cardiovascular risk.
Understanding Your Vascular Health: Essential Patient Insights
- The Silent Progression: PAD can remain asymptomatic for decades, meaning significant blockages can exist long before physical pain or cramping begins.
- The Polyvascular Danger: Because arterial disease often occurs alongside polyvascular disease, a diagnosis of PAD signals a risk of hidden plaque in other vascular beds, requiring comprehensive cardiovascular assessment.
- The Power of Risk Modification: Addressing risk factors—such as stopping smoking, engaging in exercise, lowering lipids, managing blood pressure and diabetes, and utilizing appropriate antithrombotic therapy—must stay at the heart of PAD care.
Regional Disparities and Barriers to Supervised Exercise Therapy
Moving from epidemiology to management, a second paper led by Riikka Tulamo, PhD, establishes that risk-factor modification should remain the cornerstone of PAD management. Clinicians rely on smoking cessation, exercise, lipid lowering, blood pressure control, diabetes management and appropriate antithrombotic therapy to stabilize patients.
For patients experiencing intermittent claudication, supervised exercise therapy is one of the most effective treatments, improving walking capacity and quality of life while potentially reducing the need for invasive procedures. Yet, systemic healthcare delivery fails to provide equitable access to these programs.
Supervised exercise programs remain available in only 59% of European countries. Alarmingly, just 24% of European vascular surgeons report access to such programs. Across the Atlantic, the landscape shows similar fragmentation. Studies show up to 86% variability in treatment approaches across U.S. centers alone, exposing deep geographical disparities in whether a patient receives conservative rehabilitation or endovascular and surgical interventions.
As healthcare expenditures climb, Tulamo and colleagues stress that safety, efficacy, and cost-effectiveness are crucial to the success of new therapeutic strategies. Closing the global treatment gap demands targeted investment in healthcare infrastructure, technology transfer, and global health initiatives.
| Clinical Metric | Reported Statistic / Finding | Clinical Significance |
|---|---|---|
| Global Prevalence | >113 million adults aged 40+ | Highlights a substantial burden requiring earlier diagnosis and improved treatment. |
| Advanced Mortality | 30%–50% five-year mortality in advanced stages | Exceeds the mortality rate of some cancers and acute myocardial infarction. |
| Polyvascular Overlap | 46-68% of PAD patients affected | Demonstrates widespread systemic atherosclerosis increasing cardiovascular risk. |
| Mobility Impairment | >40% of U.S. CLTI patients require assistance or a wheelchair | Illustrates functional decline in advanced disease. |
Functional Decline, Mobility Loss, and Health Disparities
The third paper in the series, spearheaded by Jonathan Golledge, MChir, and colleagues, details the severe toll advanced PAD exacts on daily living. Chronic pain, impaired mobility, mental health disorders, and amputations frequently punctuate the later stages of the disease.
A systematic review found that PAD increased the risk of falls 1.82-fold. Furthermore, upwards of 40% of Americans suffering from CLTI depend on walking assistance, rely on a wheelchair, or remain confined to a bed. Additionally, having a depressed ankle-brachial index (ABI ≤ 0.9) correlates with a two-fold escalation in the ten-year incidence of major coronary events, death from cardiovascular causes, and overall mortality from any cause.
Beyond biological drivers, socioeconomic and demographic factors dictate patient trajectories. Underserved populations consistently encounter delayed diagnoses, reduced access to specialty care, and higher rates of advanced disease and amputation. Golledge and his co-authors argue that mitigating these disparities requires a paradigm shift in the current systems for managing this disease, better reimbursement models for early-stage disease management, and standalone multidisciplinary models to deliver medical and rehabilitation care.
Contraindications & When to Consult a Physician
Patients diagnosed with or suspected of having peripheral artery disease should consult their healthcare provider. The authors provide step-by-step outlines for understanding the ankle-brachial index (ABI) and diagnosing PAD.
Early diagnostic testing using the ankle-brachial index can establish baseline vascular health.
References
- Behrendt, CA, et al. “Epidemiology, management, and future challenges of peripheral artery disease.” The Lancet, Sept. 22.
- Tulamo, R, et al. “Risk-factor modification and treatment strategies in peripheral artery disease.” The Lancet, Sept. 22.
- Golledge, J, et al. “Advanced peripheral artery disease: clinical consequences, functional outcomes, and health disparities.” The Lancet, Sept. 22.
- "Guideline for the Management of Lower Extremity Peripheral Artery Disease."
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