Prevalence of Peripheral Arterial Disease and Risk Factors in Persons Aged 60 and Older: Data from the National Health and Nutrition Examination Survey 1999–2004

Abstract

OBJECTIVES: Peripheral arterial disease (PAD) is associated with significant cardiovascular morbidity and mortality. The study objectives were to examine the prevalence of PAD and associated risk factors. DESIGN: A cross-sectional nationally representative health examination survey. SETTING: The National Health and Nutrition Examination Survey 1999–2004. PARTICIPANTS: Data from 3,947 men and women aged 60 and older who received a lower extremity examination. MEASUREMENTS: The main outcome was PAD, defined as an ankle-brachial blood pressure index of less than 0.9 in either leg. RESULTS: In older U.S. adults, PAD prevalence was 12.2% (95% confidence interval (CI) = 10.9–13.5%). PAD prevalence increased with age. PAD prevalence was 7.0% (95% CI = 5.6–8.4%) for those aged 60 to 69, 12.5% (95% CI = 10.4–14.6%), and 23.2% (95% CI = 19.8–26.7%) for those aged 70 to 79 and 80 and older. Age-adjusted estimates show that non-Hispanic black men and women and Mexican-American women had a higher prevalence of PAD than non-Hispanic white men and women (19.2%, 95% CI = 13.7–24.6%; 19.3%, 95% CI = 13.3–25.2%; and 15.6%, 95% CI = 12.7–18.6%, respectively). The results of the fully adjusted model show that current smoking (OR = 5.48, 95% CI = 3.60–8.35), previous smoking (OR = 1.94, 95% CI = 1.39–2.69), diabetes mellitus (OR = 1.81, 95% CI = 1.12–2.91), low kidney function (OR = 2.69, 95% CI = 1.58–4.56), mildly decreased kidney function (OR = 1.71, 95% CI = 1.22–2.38), high-sensitivity C-reactive protein greater than 3.0 mg/L (OR = 2.69, 95% CI = 1.24–5.85), treated but not controlled hypertension (OR = 1.95, 95% CI = 1.40–2.72), and untreated hypertension (OR = 1.68, 95% CI = 1.13–2.50) were all significantly associated with prevalent PAD. CONCLUSION: PAD prevalence increases with age and is associated with treatable risk factors for cardiovascular disease.