Lower extremity peripheral artery disease is the third leading cause of atherosclerotic
cardiovascular morbidity, following coronary artery disease and stroke. This study
provides the first comparison of the prevalence of peripheral artery disease between
high-income countries (HIC) and low-income or middle-income countries (LMIC), establishes
the primary risk factors for peripheral artery disease in these settings, and estimates
the number of people living with peripheral artery disease regionally and globally.
We did a systematic review of the literature on the prevalence of peripheral artery
disease in which we searched for community-based studies since 1997 that defined peripheral
artery disease as an ankle brachial index (ABI) lower than or equal to 0·90. We used
epidemiological modelling to define age-specific and sex-specific prevalence rates
in HIC and in LMIC and combined them with UN population numbers for 2000 and 2010
to estimate the global prevalence of peripheral artery disease. Within a subset of
studies, we did meta-analyses of odds ratios (ORs) associated with 15 putative risk
factors for peripheral artery disease to estimate their effect size in HIC and LMIC.
We then used the risk factors to predict peripheral artery disease numbers in eight
WHO regions (three HIC and five LMIC).
34 studies satisfied the inclusion criteria, 22 from HIC and 12 from LMIC, including
112,027 participants, of which 9347 had peripheral artery disease. Sex-specific prevalence
rates increased with age and were broadly similar in HIC and LMIC and in men and women.
The prevalence in HIC at age 45-49 years was 5·28% (95% CI 3·38-8·17%) in women and
5·41% (3·41-8·49%) in men, and at age 85-89 years, it was 18·38% (11·16-28·76%) in
women and 18·83% (12·03-28·25%) in men. Prevalence in men was lower in LMIC than in
HIC (2·89% [2·04-4·07%] at 45-49 years and 14·94% [9·58-22·56%] at 85-89 years). In
LMIC, rates were higher in women than in men, especially at younger ages (6·31% [4·86-8·15%]
of women aged 45-49 years). Smoking was an important risk factor in both HIC and LMIC,
with meta-OR for current smoking of 2·72 (95% CI 2·39-3·09) in HIC and 1·42 (1·25-1·62)
in LMIC, followed by diabetes (1·88 [1·66-2·14] vs 1·47 [1·29-1·68]), hypertension
(1·55 [1·42-1·71] vs 1·36 [1·24-1·50]), and hypercholesterolaemia (1·19 [1·07-1·33]
vs 1·14 [1·03-1·25]). Globally, 202 million people were living with peripheral artery
disease in 2010, 69·7% of them in LMIC, including 54·8 million in southeast Asia and
45·9 million in the western Pacific Region. During the preceding decade the number
of individuals with peripheral artery disease increased by 28·7% in LMIC and 13·1%
In the 21st century, peripheral artery disease has become a global problem. Governments,
non-governmental organisations, and the private sector in LMIC need to address the
social and economic consequences, and assess the best strategies for optimum treatment
and prevention of this disease.
Peripheral Arterial Disease Research Coalition (Europe).
Copyright © 2013 Elsevier Ltd. All rights reserved.