Materiały źródłowe

• #1 Intermittent Claudication – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430778/

  In the general population over age 60, intermittent claudication is present in 5% of men and 2.5% of women. Of all patients with peripheral arterial disease, between 10% to 35% will have a presentation of classic intermittent claudication. Certain patient groups have a higher incidence of peripheral arterial disease; these include age greater than 70, people who smoke, patients with diabetes between ages 50-69, and those with other atherosclerotic cardiovascular diseases. […] The prognosis of intermittent claudication depends on many factors. For those who continue to smoke, have uncontrolled hypertension or elevated blood glucose, the condition can progress, leading to ischemia, necrosis, and eventually culminate in the amputation of the limb. Besides smoking, two factors that negatively affect prognosis include diabetes mellitus and advanced age. Overall, the survival of patients with intermittent claudication is less than that of age-matched controls. The key reason for the shortened life expectancy is the presence of coronary artery disease. About 5% to 30% of individuals are dead at 10 years, depending on the severity of the vascular disease.

• #1 Epidemiology – The Society for Vascular Medicine

  https://myperipheralarterydisease.com/health-care-providers/addressing-patients-with-suspected-and-confirmed-pad/epidemiology/

  Peripheral artery disease (PAD) is a global health problem and ranks among the top three causes of atherosclerotic cardiovascular disease, following coronary artery disease (CAD) and stroke. Recent data suggest that more than 200 million people have PAD worldwide. PAD is more common after the age of 50 years, and its prevalence increases with age, such that 1 in 5 patients by the age of 70 years have PAD. It affects men and women equally; however, the prevalence of symptomatic or severe disease is higher among men than women. At any given age, the prevalence of PAD is 2-fold higher in African Americans than among whites. Despite advances in contemporary therapy for atherosclerotic coronary disease, the prevalence of PAD continues to increase; such as, between 2000-2010 the prevalence of PAD has increased by ~15% in high-income countries and ~30% in low to middle income countries. Several observational analyses have highlighted the burden of PAD in the United States (US); for example, in a robust retrospective cohort analysis of 12 million adults in an insurance claims database in the US, the prevalence of PAD was 11%. In another analysis of primary care patients across the US, ~30% of patients who were 70 years of age or 50 years with a history of diabetes or smoking were reported to have PAD.

• #1 Peripheral artery disease and intermittent claudication Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/report/peripheral-artery-disease-and-intermittent-claudication

  About 8 million American adults have PAD, and the prevalence of the disease is increasing worldwide. Men and women are equally susceptible although women face a greater risk for limb loss. African Americans have twice the risk for PAD as white people. Between 12% to 20% of people over age 65 suffer from the condition. […] Peripheral artery disease (PAD) is greatly under-diagnosed. Many people do not report symptoms or may not even have symptoms. […] People should be checked for PAD if they have leg pain during walking, or ulcers on their legs. People who may not have symptoms but who should be screened for PAD include those with coronary artery disease, diabetes, chronic kidney disease, or people who have had a previous stroke. […] Peripheral artery disease: epidemiology and global perspectives.

• #1 Pathophysiology of Intermittent Claudication in Peripheral Artery Disease

  https://www.jstage.jst.go.jp/article/circj/81/3/81_CJ-16-1286/_html/-char/ja

  Peripheral artery disease (PAD) affects more than 200 million adults worldwide. […] There is growing recognition of the effect of peripheral artery disease (PAD) on cardiovascular health. Recent studies indicate that, globally, over 200 million adults have PAD, which is an expression of systemic atherosclerosis and well-established as heightening the risk for cardiovascular events. […] A set of recent international studies highlights the worldwide prevalence of PAD. The Global Burden of Disease study estimates a more than 30% increase in deaths and disability attributable to PAD between 2005 and 2015, which is largely determined by population aging. […] Importantly, there has been a greater increase in PAD prevalence in low- and middle-income countries, rising by 28.7% from 2000 to 2010 as compared with 13.1% in high-income countries.

• #1 Peripheral arterial disease: Epidemiology, natural history, diagnosis and treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2733014/

  Lower extremity peripheral arterial disease (PAD) affects approximately 10% of the American population, with 30% to 40% of these patients presenting with claudication symptoms. […] The prevalence of PAD increases with age and the number of vascular risk factors. […] An American survey of 2174 patients older than 40 years of age used the ankle-brachial index (ABI) as a screening tool, and showed a PAD prevalence of 0.9% between the ages of 40 and 49 years, 2.5% between the ages of 50 and 59 years, 4.7% between the ages of 60 and 69 years, and 14.5% for the ages of 70 years and older. […] Of the patients who present with claudication, most have stable disease requiring lifestyle modifications and medical management of risk factors. […] These symptoms may involve different muscle groups based on disease distribution.

• #1 The Epidemiology of Peripheral Artery Disease – Clinical Tree

  https://clinicalpub.com/the-epidemiology-of-peripheral-artery-disease/

  While the first studies on PAD epidemiology focused on symptomatic disease only, the development of investigative methods applicable in large cohorts enabled the identification of asymptomatic PAD. […] Recent estimates place the total number of persons with PAD at more than 8 million in the United States and 200 million worldwide. […] The current prevalence of PAD worldwide is estimated at approximately 200 million people. In the United States, pooling and adjusting the data of seven US population studies provided an estimate of approximately 6.8 million people aged 40 years affected by this condition in the year 2000, corresponding to 5.8% of that population. […] A recent meta-analysis also estimated the prevalence of PAD in the United States. In men, this prevalence ranged from 6.5% at age of 60 to 69 to 11.6% in those at age of 70 to 79, and 29.4% in those over the age of 80 years.

• #1 Peripheral Arterial Disease: Symptoms and Treatment | Doctor

  https://patient.info/doctor/peripheral-arterial-disease-pro

  PAD affects over 200 million adults worldwide and the incidence of PAD increases to as high as 20% in people over the age of 70.3 […] In the Framingham Study, the incidence of intermittent claudication in men rose from 0.4 per 1,000 aged 35-45 years to 6 per 1,000 aged 65 years and older. The incidence in women was about half that in men but was more similar at older ages.6 […] The ankle-brachial index (ABI) is a low-cost, easy, and largely used tool, used both at rest or after exercise for PAD diagnosis and surveillance.9 Both oscillometric and Doppler methods have shown good concordance.

• #1 Epidemiology – Primary Care Notebook

  https://primarycarenotebook.com/pages/cardiovascular-medicine/arterial-large-vessel-disease/epidemiology

  the most accurate studies of peripheral arterial disease (PAD) use an abnormal ankle-brachial pressure index (0.95) to detect cases. Using this approach the frequency of PAD in the population aged 45-74 is 6.9%, however only 22% of these cases are symptomatic (Stoffers et al. 1996). […] Stoffers et al. found that the frequency of intermittent claudication increases with age (Fig.1). […] More recently NICE stated that „.. about 20% of people aged over 60 years have some degree of peripheral arterial disease…incidence is also high in people who smoke, people with diabetes and people with coronary artery disease..in most people with intermittent claudication the symptoms remain stable, but approximately 20% will develop increasingly severe symptoms with the development of critical limb ischaemia..”

• #1 Peripheral arterial disease – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/peripheral-arterial-disease/

  Prevalence: 1012 million in the US […] Prevalence increases with age, starting from the age of 40. […] Incidence is highest among African American individuals, followed by Hispanic and non-Hispanic White individuals. […] Peripheral arterial disease is equally common in women and men. […] Epidemiological data refers to the US, unless otherwise specified.

• #1 The Epidemiology of Peripheral Artery Disease – Clinical Tree

  https://clinicalpub.com/the-epidemiology-of-peripheral-artery-disease/

  More recently, several studies shed light on PAD epidemiology in the populations of non-Western countries. […] Data suggesting that PAD is more common in the black population are compelling in studies from both the United States and Africa. […] The higher prevalence of PAD in African-Americans is consistent in all large American epidemiological studies. […] There is also evidence that Asians and Hispanics have a lower prevalence of PAD than whites. […] Estimates of PAD incidence are reported somewhat less frequently in the literature, with more data for claudication incidence than for ABI. […] Data on temporal changes in PAD incidence and prevalence are very scarce. […] In the Framingham study, a decrease of incident IC was reported, from 282 per 100,000 person-years during the 1950 to 1959 period to 225 per 100,000 person-years during the 1990 to 1999 period. […] More recently, a population-based study in the United Kingdom showed a significant drop in incident cases of symptomatic PAD from 38.6 per 10,000 person-years in 2000 to 17.3 in 2014.

• #1

  https://journals.lww.com/cardiovascularpharm/abstract/1994/00233/epidemiology_of_peripheral_arterial_disease.3.aspx

  With the aging of the population of most developing nations, arteriosclerosis is becoming a major health problem. […] Peripheral arterial disease has received little attention from epidemiologists. […] 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. […] 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.

• #1 Patient education: Peripheral artery disease and claudication (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/peripheral-artery-disease-and-claudication-beyond-the-basics

  Claudication is the development of pain deep in the muscles of the leg (calves, thighs, or buttocks) during activity; the pain is relieved by resting the legs. Claudication, which literally means „to limp,” is one of the symptoms of lower extremity peripheral artery disease (PAD), which is when blockages in the arteries prevent blood from easily flowing through. […] Although other underlying medical problems can also cause claudication, PAD is the most common cause. PAD is caused by deposits of fatty plaques (atherosclerosis) within the vessel walls. […] The major risk factors for developing peripheral artery disease (PAD) include: Cigarette smoking, Diabetes, Hyperlipidemia (elevated blood levels of lipids, including cholesterol and triglycerides), Hypertension (high blood pressure), Physical inactivity.

• #1 Epidemiology of peripheral artery disease | Health & Environmental Research Online (HERO) | US EPA

  https://hero.epa.gov/hero/index.cfm/reference/details/reference_id/6746884

  The major risk factors for PAD are similar to those for coronary and cerebrovascular disease, with some differences in the relative importance of factors. […] Smoking is a particularly strong risk factor for PAD, as is diabetes mellitus, and several newer risk markers have shown independent associations with PAD. […] PAD is strongly associated with concomitant coronary and cerebrovascular diseases. […] After adjustment for known cardiovascular disease risk factors, PAD is associated with an increased risk of incident coronary and cerebrovascular disease morbidity and mortality.

• #1 Peripheral Arterial Occlusive Disease: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/460178-overview

  Claudication, which is defined as reproducible ischemic muscle pain, is one of the most common manifestations of peripheral arterial occlusive disease (PAOD) caused by atherosclerosis. Claudication occurs during physical activity and is relieved after a short rest. Pain develops because of inadequate blood flow. […] Estimated PAOD prevalence in the general US population, based on National Health and Nutrition Examination Survey (NHANES) data, was 4.3%. Thus in 2000, about 5 million people in the US were affected by PAOD. That number increases with age; therefore, as the population ages the number of people affected by PAOD increases. […] When claudication is used as an indicator, it is estimated that 2% of the population aged 40-60 years and 6% of the population older than 70 years are affected. Intermittent claudication most commonly manifests in men older than 50 years. Although younger patients may present with symptoms consistent with intermittent claudication, other etiologies of leg pain and claudication (eg, popliteal entrapment syndrome) must be strongly considered. There seems to be a higher prevalence of PAOD in non-Hispanic blacks.

• #1

  https://step2.medbullets.com/cardiovascular/120033/arterial-insufficiency

  Epidemiology […] Demographics […] affects older patients […] […] […] Location […] most commonly affects the popliteal artery […] […] […] Risk factors […] smoking […] hypertension […] hyperlipidemia […] family history […] renal disease […] diabetes

• #1 Epidemiology and prognosis of peripheral arterial occlusive disease (PAOD)

  https://lirias.kuleuven.be/1421402

  The incidence of chronic critical ischaemia is estimated to be between 0.05% and 0.1% of the population. […] Asymptomatic disease detected with noninvasive tests is 3 to 4 times more frequent than intermittent claudication: its prevalence increases from under 5% for individuals aged less than 50 years to over 20% for individuals aged more than 70 years. […] The classical risk factors for atherosclerosis also apply to peripheral arterial disease, although their order of importance may be different from that for coronary and carotid disease. […] Several studies have shown that peripheral arterial disease correlates most strongly with cigarette smoking. […] Smoking is also the single greatest predictor of the progression of peripheral arterial disease. […] The general prognosis for patients with peripheral arterial disease is particularly negative.

• #1 Peripheral arterial disease: Epidemiology, natural history, diagnosis and treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2733014/

  Claudication is defined as fatigue, discomfort or pain that occurs due to exercise-induced ischemia in specific limb muscle groups. […] Most of the data suggest that classic claudication is present in only a small percentage of patients with PAD. […] The ABI also serves as a surrogate marker of the overall atherosclerotic burden. […] The ABI is a simple and effective test for diagnosing PAD. […] Most patients with lifestyle-limiting claudication can be treated with endovascular techniques, with a few individuals requiring vascular bypass surgery.

• #1 Intermittent Claudication: Definition, Symptoms, Treatment, and More

  https://www.healthline.com/health/intermittent-claudication

  Intermittent claudication is a common early symptom of PAD. […] PAD affects about 8.5 million Americans, according to the U.S. Centers for Disease Control and Prevention. […] Its estimated that about 20 percent of the population over 65 has intermittent claudication due to PAD. […] The most important screening test for PAD/intermittent claudication is the ankle-brachial index (ABI). […] The ankle-brachial index may be sufficient to diagnose PAD as the cause of your intermittent claudication. […] If PAD is the cause of intermittent claudication, its treatable but not curable. […] Most important is treatment for any cardiovascular disease. […] In an article written in 2001, as many as 90 percent of people with intermittent claudication were found to have cardiovascular disease.

• #1 Treatment Strategies for Patients With Peripheral Artery Disease (PAD) | Effective Health Care (EHC) Program

  https://effectivehealthcare.ahrq.gov/products/peripheral-artery-disease-treatment/research-protocol

  Peripheral artery disease (PAD) is the preferred clinical term for describing stenosis or occlusion of upper- or lower-extremity arteries due to atherosclerotic or thromboembolic disease. […] PAD represents a spectrum of disease severity, encompassing both asymptomatic and symptomatic disease. About 20 to 50 percent of patients diagnosed with PAD (diagnosis made by abnormal results of an ankle-brachial index [ABI] test discussed in the next section) are asymptomatic, though they usually have functional impairment when tested. […] About 10 to 35 percent of all PAD patients report symptoms of classic IC, and 40 to 50 percent of patients present with the atypical form. […] The prevalence of PAD increases with age, such that about 20 percent of patients over age 65 have PAD (including symptomatic and asymptomatic).

• #1 The Natural History of Intermittent Claudication – Endovascular Today

  https://evtoday.com/articles/2019-sept/the-natural-history-of-intermittent-claudication

  Intermittent claudication can progress with worsening symptoms that become lifestyle limiting if not appropriately treated. Intermittent claudication is a stable or slowly progressive disease. […] In short, patients with intermittent claudication are largely stable over the acute and intermediate terms. […] The natural history of intermittent claudication is beset by both limb morbidity and cardiovascular morbidity and mortality. The symptom complex of claudication, for most patients, slowly and progressively declines over time. Markers of adverse limb prognosis include diabetes mellitus, severe PAD as measured by low ABI, polyvascular disease, microvascular disease, and continued smoking. As with manifestations of atherosclerosis in other vascular beds, the rates of MI, stroke, and death are significantly increased compared to patients without PAD.

• #1 The Natural History of Intermittent Claudication – Endovascular Today

  https://evtoday.com/articles/2019-sept/the-natural-history-of-intermittent-claudication

  Intermittent claudication is described as a symptom pattern that includes the development of limb muscular discomfort commonly described as burning, aching, or heaviness at a predictable amount of walking that is relieved with a predictable amount of rest (approximately 5-10 minutes of rest). It includes neither pain at rest nor pain with standing. However, this textbook definition describes the minority of patients with symptoms arising from peripheral artery disease (PAD). Only approximately 20% to 30% of patients with known PAD present with classic symptoms of intermittent claudication. […] Patients with PAD can experience clinical worsening over time. There are three forms of symptom worsening in the limbs: progressive claudication, development of critical limb ischemia (CLI), and occurrence of acute limb ischemia (ALI).

• #1 Lower Extremity Peripheral Artery Disease: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0315/p362.html

  The reported incidence of PAD and CLI varies depending on the population studied. Up to 21% of patients with intermittent claudication may progress to CLI. […] Annual mortality rates of patients with CLI are approximately 25%. […] PAD is considered a coronary artery disease risk equivalent, and patients with PAD are at increased risk for major adverse cardiac events (MACE), including myocardial infarction (MI), ischemic stroke, and cardiovascular death. […] Current guidelines endorse supervised exercise therapy as a first-line treatment for all patients with PAD. […] Current AHA/ACC guidelines recommend antiplatelet therapy with aspirin alone (75 to 325 mg per day) or clopidogrel (Plavix) alone (75 mg per day) to reduce the risk of MI, stroke, and vascular death in patients with symptomatic PAD.

• #1 Epidemiology – The Society for Vascular Medicine

  https://myperipheralarterydisease.com/health-care-providers/addressing-patients-with-suspected-and-confirmed-pad/epidemiology/

  The presence of PAD is independently associated with increased morbidity and mortality. Even after adjusting for traditional risk factors, PAD is a strong predictor of systemic atherothrombotic events such as all-cause mortality, cardiovascular death, myocardial infarction, and stroke. Furthermore, PAD also results in profound disability and poor quality of life due to claudication, ischemic rest pain, foot ulcers, acute limb ischemia, recurrent hospitalizations, need for revascularization, and amputation. Concerningly, recent reports from the global burden of disease database from developing and developed nations have shown that mortality and disability secondary to PAD has significantly increased over the last two decades. Despite the rising prevalence, the diagnosis of PAD is routinely ignored, and these patients are less frequently treated with evidence-based therapy for atherosclerotic disease than those with coronary disease.

• #1 Critical Limb Ischemia: Epidemiology | Methodist DeBakey Cardiovascular J

  https://journal.houstonmethodist.org/articles/10.14797/mdcj-8-4-10

  Critical limb ischemia is found in 12% of the U.S. adult population. […] Those with critical limb ischemia have a high incidence of cardiovascular comorbidities that reflect a significant systemic atherosclerotic burden; they have increased functional impairment and increased rates of functional decline compared with persons without critical limb ischemia. […] At 1 year, 25% of patients will be dead, 30% will have undergone amputation, and only 45% will remain alive with both limbs. […] At 5 years, more than 60% of patients with critical limb ischemia will be dead.

• #1 Cilostazol for Intermittent Claudication Caused by Peripheral Artery Disease | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/0400/p366.html

  PAD affects up to 12% of people 55 to 69 years of age and 20% of people older than 70 years. A sensation of heaviness and fatigue in the leg muscles, known as vascular claudication, is present in 60% of patients with PAD. Intermittent claudication secondary to PAD is an indicator of increased systemic atherosclerosis. […] Compared with age-matched controls, patients who experience intermittent claudication have a higher risk of amputation and cardiovascular mortality over five years. […] More research is needed to assess the impact of pharmacologic treatment of PAD sequelae, including vascular claudication and the subsequent need for surgical intervention.

• #1 The fate of patients with intermittent claudication in the 21st century revisited – results from the CAVASIC Study | Scientific Reports

  https://www.nature.com/articles/srep45833

  Patients with intermittent claudication carry a high risk for cardiovascular complications. The TransAtlantic Inter-Society Consensus (TASC) Group estimated a five-year overall mortality of 30% for these patients, the majority dying from cardiovascular causes. […] Overall mortality reached 16.1% (n=41). Most patients died from cancer (n=20). […] Incident cardiovascular events were observed among 70 patients (27.5%), 54 (21.2%) during the first five years. Vascular mortality was low with 5.1% (n=13) for the entire and 3.1% for the first five years of follow-up. […] In summary, compared to TASC, the proportion of cardiovascular events did not markedly decrease over the last two decades. Vascular mortality, however, was low among our population. This indicates that nowadays patients more often survive cardiovascular events and a major number dies from cancer.

• #1 The Epidemiology of Peripheral Artery Disease | Thoracic Key

  https://thoracickey.com/the-epidemiology-of-peripheral-artery-disease/

  The case for an excess of disease among males is even weaker for PAD diagnosed based on ABI. […] The greater male excess observed for symptomatic versus ABI-diagnosed disease may be related to severity of disease. […] The study of PAD epidemiology raises a number of methodological issues that should be kept in mind while reviewing the literature.

• #1 The Epidemiology of Peripheral Artery Disease | Thoracic Key

  https://thoracickey.com/the-epidemiology-of-peripheral-artery-disease/

  Peripheral artery disease (PAD) is generally defined as partial or complete obstruction of one or more peripheral arteries due to atherosclerosis. […] Peripheral artery disease that exhibits typical symptomatology, usually in the form of leg pain brought about by walking, has been conservatively estimated to reduce quality of life in at least 2 million Americans, and in some cases leads to a need for surgical revascularization or amputation. […] Six million more Americans have measurable asymptomatic disease or disease with atypical symptoms. […] Both symptomatic and asymptomatic PAD have been shown to be associated with a sharply elevated risk of mortality due to coronary and cerebrovascular disease. […] Early studies of PAD focused primarily on claudication as the chief symptomatic manifestation of PAD.

• #1 The Epidemiology of Peripheral Artery Disease | Thoracic Key

  https://thoracickey.com/the-epidemiology-of-peripheral-artery-disease/

  Although intermittent claudication is an important manifestation of PAD, it is not pathognomonic. […] The ABI has been shown to have good receiver operating curve characteristics as a test for PAD. […] Peripheral artery disease based on ABI criteria is much more common than claudication in the general population, and large numbers of patients without claudication can be shown to have either atypical or no symptoms in the presence of PAD based on ABI. […] Although uncommon among younger people, the prevalence of PAD rises sharply with age to include a substantial proportion of the elderly population. […] Estimates of PAD incidence are reported somewhat less frequently in the literature, with more data based on claudication incidence than on ABI. […] Claudication incidence and prevalence have usually been found to be higher in men than women.

• #1 Epidemiology of Peripheral Vascular Disease | SpringerLink

  https://link.springer.com/chapter/10.1385/1-59259-908-7:419

  The epidemiology of several atherosclerotic arterial diseases and their association with diabetes will be covered in this chapter. […] This chapter will focus on peripheral vascular disease (PVD), arterial disease affecting the extremities, and will include more general epidemiological aspects of PVD, including associated conditions and mortality. […] The epidemiology of peripheral arterial disease: importance of identifying the population at risk. […] Epidemiology of intermittent claudication: evaluation of risk factors. […] The Edinburgh Claudication Questionnaire: an improved version of the WHO/Rose Questionnaire for use in epidemiological surveys. […] Epidemiology of peripheral vascular disease. […] Update on some epidemiologic features of intermittent claudication: the Framingham Study. […] Mortality over a period of 10 years in patients with peripheral arterial disease. […] Intermittent claudication and subsequent cardiovascular disease in the elderly. […] Relationship of severity of lower limb peripheral vascular disease to mortality and morbidity: a six-year follow-up study.

• #1 Epidemiology of peripheral artery disease | Health & Environmental Research Online (HERO) | US EPA

  https://hero.epa.gov/hero/index.cfm/reference/details/reference_id/6746884

  New data on the epidemiology of peripheral artery disease (PAD) are available, and they should be integrated with previous data. […] We provide an updated, integrated overview of the epidemiology of PAD, a focused literature review was conducted on the epidemiology of PAD. […] The most common symptom of PAD is intermittent claudication, but noninvasive measures, such as the ankle-brachial index, show that asymptomatic PAD is several times more common in the population than intermittent claudication. […] PAD prevalence and incidence are both sharply age-related, rising 10% among patients in their 60s and 70s. […] With aging of the global population, it seems likely that PAD will be increasingly common in the future. […] Prevalence seems to be higher among men than women for more severe or symptomatic disease.

• #1 The Epidemiology of Peripheral Artery Disease | Clinical Gate

  https://clinicalgate.com/the-epidemiology-of-peripheral-artery-disease/

  The case for an excess of disease among males is even weaker for PAD diagnosed based on ABI. […] The greater male excess observed for symptomatic versus ABI-diagnosed disease may be related to severity of disease. […] The study of PAD epidemiology raises a number of methodological issues that should be kept in mind while reviewing the literature. […] The following discussion of risk factors focuses on the results from five large epidemiological studies referred to as index studies. […] The association of hypertension with PAD has been demonstrated in most studies in which blood pressure was studied. […] Given the common risk factors for PAD and other cardiovascular and cerebrovascular diseases, it is not surprising that cross-sectionally, people with PAD are more likely to have these other disorders, and vice versa.

• #1 Peripheral artery disease in the lower limbs: The importance of secondary risk prevention for improved long-term prognosis

  https://www1.racgp.org.au/ajgp/2020/may/peripheral-artery-disease-in-lower-limbs

  Patients with lower limb peripheral artery disease (PAD) are at high risk of cardiovascular mortality and morbidity along with limb loss. […] PAD continues to be a major contributor to the mortality and morbidity of patients with atherosclerosis in Australia. […] Both prescription of, and adherence to, evidence-based secondary prevention therapy is low. […] A greater emphasis on cardiovascular risk factor modification for all patients with PAD is required to improve long-term outcomes. […] The identification of patients with PAD is important because of the increased risk of cardiovascular and lower limb morbidity and mortality. […] Patients with PAD have a 34-fold increased risk of acute myocardial infarction (AMI) and a 1015 times greater risk of cardiovascular mortality when compared with those without PAD.

• #1 Peripheral artery disease in the lower limbs: The importance of secondary risk prevention for improved long-term prognosis

  https://www1.racgp.org.au/ajgp/2020/may/peripheral-artery-disease-in-lower-limbs

  The PAD population continues to be underdiagnosed and undertreated for cardiovascular risk factors. […] There is a need for good partnership between GPs and vascular surgeons to work together to address the needs of this high-risk group of patients. […] For all patients with PAD, treatment to address ongoing cardiovascular risk factors is essential. […] Long-term outcomes related to mortality and lower limb events are improved with adherence to these four guideline-recommended treatments. […] Despite this, few patients are prescribed treatment according to guidelines, with population-based studies, both in Australia and internationally, showing that only approximately one-third of patients with lower limb arterial disease are optimised on appropriate medical therapies.

• #1 Pathophysiology of Intermittent Claudication in Peripheral Artery Disease

  https://www.jstage.jst.go.jp/article/circj/81/3/81_CJ-16-1286/_html/-char/ja

  The health implications of PAD derive from both its limb and cardiovascular manifestations. […] Risk reduction therapy continues to be underutilized in patients with PAD. […] Patients with PAD suffer from limb disability. […] Intermittent claudication is present in only 10-20% of PAD patients. […] Reduced walking function in patients with PAD is associated with poor clinical outcomes. […] Patients with PAD experience intermittent claudication, characterized as exertional leg pain that limits walking ability, and often times, disability. […] Robust evidence supports the utility of exercise training programs to improve walking function in patients with PAD. […] In patients with claudication, exercise is the most effective noninterventional approach to reducing leg symptoms. […] The available trial evidence indicates that exercise training and revascularization are complementary approaches to treating limb symptoms. […] An enhanced understanding of the pathophysiology of leg symptoms in PAD is critical for the development of novel therapeutic approaches.

• #1 Supervised exercise therapy apps for claudication – Journal of Vascular Societies Great Britain and Ireland JVSGBI

  https://jvsgbi.com/supervised-exercise-therapy-apps-for-claudication/

  Peripheral arterial disease (PAD) has been recognised as a healthcare burden affecting up to 5.56% of the global population over 25 years of age. […] The prevalence of PAD has increased by 25% over the last decade and this trend is expected to continue. […] A survey of UK vascular units identified that only 38.5% of vascular units had access to SET, with the majority based in hospital facilities. Of all patients referred for SET, less than 60% attended a single session. […] Institutional barriers contributing to poor SET implementation include lack of funding, facilities, resources, trained staff and poor referral pathways. […] Patient barriers contributing to poor attendance and compliance are multifactorial and include time constraints, motivation, transportation, financial and psychological barriers. […] Although mHealth has been in the background over the last 20 years or so, the pandemic has played a significant role in bringing it into the limelight. […] There is huge potential to tap into mHealth technology to better promote and deliver SET.

• #2 Patient education: Peripheral artery disease and claudication (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/peripheral-artery-disease-and-claudication-beyond-the-basics

  Claudication is the development of pain deep in the muscles of the leg (calves, thighs, or buttocks) during activity; the pain is relieved by resting the legs. Claudication, which literally means „to limp,” is one of the symptoms of lower extremity peripheral artery disease (PAD), which is when blockages in the arteries prevent blood from easily flowing through. […] Although other underlying medical problems can also cause claudication, PAD is the most common cause. PAD is caused by deposits of fatty plaques (atherosclerosis) within the vessel walls. […] The major risk factors for developing peripheral artery disease (PAD) include: Cigarette smoking, Diabetes, Hyperlipidemia (elevated blood levels of lipids, including cholesterol and triglycerides), Hypertension (high blood pressure), Physical inactivity.

• #2 Exercise training for intermittent claudication: a narrative review and summary of guidelines for practitioners | BMJ Open Sport & Exercise Medicine

  https://bmjopensem.bmj.com/content/6/1/e000897

  Peripheral artery disease (PAD) is caused by atherosclerotic narrowing of the arteries supplying the lower limbs often resulting in intermittent claudication, evident as pain or cramping while walking. […] The most classic symptom of PAD is intermittent claudication (IC). This is ischaemic muscle pain that usually presents in the calves (but can include the thighs or buttocks), is precipitated by exertion and relieved with rest. […] PAD is a common problem thought to affect over 200 million people worldwide. […] The total disease prevalence is approximately 13% of adults 50 years old, with major risk factors including smoking, diabetes and dyslipidaemia. […] Treatment for patients with IC involves secondary prevention of cardiovascular disease risk, including smoking cessation, diet changes, lipid modification, statin therapy, antiplatelet therapy and management of diabetes and hypertension.

• #2 Peripheral Arterial Occlusive Disease

  https://fpnotebook.com/Surgery/CV/PrphrlArtrlOclsvDs.htm

  Overall 7-12 million affected in United States. […] 200 million affected worldwide. […] Age over 60 years: 3 to 6%. […] Age over 70 years: 10 to 18%. […] Age over 85 years: 50%. […] Intermittent Claudication progresses to Critical Limb Ischemia in 21% of cases. […] Critical Limb Ischemia is associated with a 25% annual mortality rate (esp. due to cardiovascular cause).

• #2 Pathophysiology of Intermittent Claudication in Peripheral Artery Disease

  https://www.jstage.jst.go.jp/article/circj/81/3/81_CJ-16-1286/_html/-char/ja

  Peripheral artery disease (PAD) affects more than 200 million adults worldwide. […] There is growing recognition of the effect of peripheral artery disease (PAD) on cardiovascular health. Recent studies indicate that, globally, over 200 million adults have PAD, which is an expression of systemic atherosclerosis and well-established as heightening the risk for cardiovascular events. […] A set of recent international studies highlights the worldwide prevalence of PAD. The Global Burden of Disease study estimates a more than 30% increase in deaths and disability attributable to PAD between 2005 and 2015, which is largely determined by population aging. […] Importantly, there has been a greater increase in PAD prevalence in low- and middle-income countries, rising by 28.7% from 2000 to 2010 as compared with 13.1% in high-income countries.

• #2 Peripheral arterial disease: Epidemiology, natural history, diagnosis and treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2733014/

  Lower extremity peripheral arterial disease (PAD) affects approximately 10% of the American population, with 30% to 40% of these patients presenting with claudication symptoms. […] The prevalence of PAD increases with age and the number of vascular risk factors. […] An American survey of 2174 patients older than 40 years of age used the ankle-brachial index (ABI) as a screening tool, and showed a PAD prevalence of 0.9% between the ages of 40 and 49 years, 2.5% between the ages of 50 and 59 years, 4.7% between the ages of 60 and 69 years, and 14.5% for the ages of 70 years and older. […] Of the patients who present with claudication, most have stable disease requiring lifestyle modifications and medical management of risk factors. […] These symptoms may involve different muscle groups based on disease distribution.

• #2 The Epidemiology of Peripheral Artery Disease – Clinical Tree

  https://clinicalpub.com/the-epidemiology-of-peripheral-artery-disease/

  While the first studies on PAD epidemiology focused on symptomatic disease only, the development of investigative methods applicable in large cohorts enabled the identification of asymptomatic PAD. […] Recent estimates place the total number of persons with PAD at more than 8 million in the United States and 200 million worldwide. […] The current prevalence of PAD worldwide is estimated at approximately 200 million people. In the United States, pooling and adjusting the data of seven US population studies provided an estimate of approximately 6.8 million people aged 40 years affected by this condition in the year 2000, corresponding to 5.8% of that population. […] A recent meta-analysis also estimated the prevalence of PAD in the United States. In men, this prevalence ranged from 6.5% at age of 60 to 69 to 11.6% in those at age of 70 to 79, and 29.4% in those over the age of 80 years.

• #2 The Epidemiology of Peripheral Artery Disease – Clinical Tree

  https://clinicalpub.com/the-epidemiology-of-peripheral-artery-disease/

  More recently, several studies shed light on PAD epidemiology in the populations of non-Western countries. […] Data suggesting that PAD is more common in the black population are compelling in studies from both the United States and Africa. […] The higher prevalence of PAD in African-Americans is consistent in all large American epidemiological studies. […] There is also evidence that Asians and Hispanics have a lower prevalence of PAD than whites. […] Estimates of PAD incidence are reported somewhat less frequently in the literature, with more data for claudication incidence than for ABI. […] Data on temporal changes in PAD incidence and prevalence are very scarce. […] In the Framingham study, a decrease of incident IC was reported, from 282 per 100,000 person-years during the 1950 to 1959 period to 225 per 100,000 person-years during the 1990 to 1999 period. […] More recently, a population-based study in the United Kingdom showed a significant drop in incident cases of symptomatic PAD from 38.6 per 10,000 person-years in 2000 to 17.3 in 2014.

• #2 Peripheral arterial disease – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/peripheral-arterial-disease/

  Prevalence: 1012 million in the US […] Prevalence increases with age, starting from the age of 40. […] Incidence is highest among African American individuals, followed by Hispanic and non-Hispanic White individuals. […] Peripheral arterial disease is equally common in women and men. […] Epidemiological data refers to the US, unless otherwise specified.

• #2 Peripheral Arterial Occlusive Disease: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/460178-overview

  Claudication, which is defined as reproducible ischemic muscle pain, is one of the most common manifestations of peripheral arterial occlusive disease (PAOD) caused by atherosclerosis. Claudication occurs during physical activity and is relieved after a short rest. Pain develops because of inadequate blood flow. […] Estimated PAOD prevalence in the general US population, based on National Health and Nutrition Examination Survey (NHANES) data, was 4.3%. Thus in 2000, about 5 million people in the US were affected by PAOD. That number increases with age; therefore, as the population ages the number of people affected by PAOD increases. […] When claudication is used as an indicator, it is estimated that 2% of the population aged 40-60 years and 6% of the population older than 70 years are affected. Intermittent claudication most commonly manifests in men older than 50 years. Although younger patients may present with symptoms consistent with intermittent claudication, other etiologies of leg pain and claudication (eg, popliteal entrapment syndrome) must be strongly considered. There seems to be a higher prevalence of PAOD in non-Hispanic blacks.

• #2 Treatment Strategies for Patients With Peripheral Artery Disease (PAD) | Effective Health Care (EHC) Program

  https://effectivehealthcare.ahrq.gov/products/peripheral-artery-disease-treatment/research-protocol

  Given that PAD represents a more systemic atherosclerotic process that is similar to atherosclerotic disease of the coronary vessels, it is not surprising that PAD shares similar risk factors: male sex, older age, diabetes, smoking, hypertension, high cholesterol, and renal insufficiency. […] Furthermore, PAD is known to be associated with a reduction in functional capacity; quality of life; and an increased risk for myocardial infarction, stroke, and death. PAD is also a major cause of limb amputation.

• #2 Epidemiology and prognosis of peripheral arterial occlusive disease (PAOD)

  https://lirias.kuleuven.be/1421402

  The incidence of chronic critical ischaemia is estimated to be between 0.05% and 0.1% of the population. […] Asymptomatic disease detected with noninvasive tests is 3 to 4 times more frequent than intermittent claudication: its prevalence increases from under 5% for individuals aged less than 50 years to over 20% for individuals aged more than 70 years. […] The classical risk factors for atherosclerosis also apply to peripheral arterial disease, although their order of importance may be different from that for coronary and carotid disease. […] Several studies have shown that peripheral arterial disease correlates most strongly with cigarette smoking. […] Smoking is also the single greatest predictor of the progression of peripheral arterial disease. […] The general prognosis for patients with peripheral arterial disease is particularly negative.

• #2 Intermittent Claudication – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430778/

  In the general population over age 60, intermittent claudication is present in 5% of men and 2.5% of women. Of all patients with peripheral arterial disease, between 10% to 35% will have a presentation of classic intermittent claudication. Certain patient groups have a higher incidence of peripheral arterial disease; these include age greater than 70, people who smoke, patients with diabetes between ages 50-69, and those with other atherosclerotic cardiovascular diseases. […] The prognosis of intermittent claudication depends on many factors. For those who continue to smoke, have uncontrolled hypertension or elevated blood glucose, the condition can progress, leading to ischemia, necrosis, and eventually culminate in the amputation of the limb. Besides smoking, two factors that negatively affect prognosis include diabetes mellitus and advanced age. Overall, the survival of patients with intermittent claudication is less than that of age-matched controls. The key reason for the shortened life expectancy is the presence of coronary artery disease. About 5% to 30% of individuals are dead at 10 years, depending on the severity of the vascular disease.

• #2 The Epidemiology of Peripheral Artery Disease | Clinical Gate

  https://clinicalgate.com/the-epidemiology-of-peripheral-artery-disease/

  The case for an excess of disease among males is even weaker for PAD diagnosed based on ABI. […] The greater male excess observed for symptomatic versus ABI-diagnosed disease may be related to severity of disease. […] The study of PAD epidemiology raises a number of methodological issues that should be kept in mind while reviewing the literature. […] The following discussion of risk factors focuses on the results from five large epidemiological studies referred to as index studies. […] The association of hypertension with PAD has been demonstrated in most studies in which blood pressure was studied. […] Given the common risk factors for PAD and other cardiovascular and cerebrovascular diseases, it is not surprising that cross-sectionally, people with PAD are more likely to have these other disorders, and vice versa.

• #2 Peripheral arterial disease: Epidemiology, natural history, diagnosis and treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2733014/

  Claudication is defined as fatigue, discomfort or pain that occurs due to exercise-induced ischemia in specific limb muscle groups. […] Most of the data suggest that classic claudication is present in only a small percentage of patients with PAD. […] The ABI also serves as a surrogate marker of the overall atherosclerotic burden. […] The ABI is a simple and effective test for diagnosing PAD. […] Most patients with lifestyle-limiting claudication can be treated with endovascular techniques, with a few individuals requiring vascular bypass surgery.

• #2 Lower Extremity Peripheral Artery Disease: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0315/p362.html

  Lower extremity peripheral artery disease (PAD) affects 12% to 20% of Americans 60 years and older. […] A variety of leg symptoms that differ from classic claudication affects 50% of patients, and 40% have no leg symptoms at all. […] Atherosclerotic lower extremity artery occlusive disease commonly referred to as peripheral artery disease (PAD) affects 12% to 20% of Americans 60 years and older, increasing to nearly 50% in those 85 years and older. […] The global disease burden exceeds 200 million persons worldwide, and PAD increased in prevalence by 23.5% between 2000 and 2010. […] The 2016 American Heart Association/American College of Cardiology (AHA/ACC) guideline on the management of patients with lower extremity PAD recommends patients at increased risk of PAD should be assessed for exertional leg symptoms, ischemic rest pain, and nonhealing wounds.

• #2 The fate of patients with intermittent claudication in the 21st century revisited – results from the CAVASIC Study | Scientific Reports

  https://www.nature.com/articles/srep45833

  The updated version of the TASC consensus document from 2007 – TASC II – contained slightly changed complication estimates predicting about 20% non-fatal cardiovascular events and proportion of deaths ranging between 10% and 15%, predominantly due to vascular causes. […] The percentage of non-fatal cardiovascular events of 18% within five years observed in the CAVASIC Study was comparable with the estimated numbers derived by TASC II (20%). […] The earlier TASC estimates resulted from population-based studies from the 1990s that have investigated the association between peripheral arterial disease and cardiovascular complications. […] Noteworthy seems the fact that merely 8 out of these 22 patients from our study died due to vascular causes within five years (3.1%). This is much lower than proposed in the TASC consensus document where the vascular mortality is stated to be 23% for five years of follow-up. Even during the entire follow-up time only 13 of our patients (5.1%) died from vascular complications, the vast majority due to heart failure. […] The CAVASIC Study has strengths and limitations. It offers not only cross-sectional data but delivers prospective long-term follow-up data of a well-defined population of patients with intermittent claudication.

• #2 The Epidemiology of Peripheral Artery Disease | Clinical Gate

  https://clinicalgate.com/the-epidemiology-of-peripheral-artery-disease/

  Peripheral artery disease (PAD) is generally defined as partial or complete obstruction of one or more peripheral arteries due to atherosclerosis. […] Peripheral artery disease that exhibits typical symptomatology, usually in the form of leg pain brought about by walking, has been conservatively estimated to reduce quality of life in at least 2 million Americans, and in some cases leads to a need for surgical revascularization or amputation. […] Six million more Americans have measurable asymptomatic disease or disease with atypical symptoms. […] Both symptomatic and asymptomatic PAD have been shown to be associated with a sharply elevated risk of mortality due to coronary and cerebrovascular disease. […] Early studies of PAD focused primarily on claudication as the chief symptomatic manifestation of PAD.

• #2 The Epidemiology of Peripheral Artery Disease | Clinical Gate

  https://clinicalgate.com/the-epidemiology-of-peripheral-artery-disease/

  Although intermittent claudication is an important manifestation of PAD, it is not pathognomonic. […] The ABI has been shown to have good receiver operating curve characteristics as a test for PAD. […] Peripheral artery disease based on ABI criteria is much more common than claudication in the general population, and large numbers of patients without claudication can be shown to have either atypical or no symptoms in the presence of PAD based on ABI. […] Although uncommon among younger people, the prevalence of PAD rises sharply with age to include a substantial proportion of the elderly population. […] Estimates of PAD incidence are reported somewhat less frequently in the literature, with more data based on claudication incidence than on ABI. […] Claudication incidence and prevalence have usually been found to be higher in men than women.

• #2 ECQ | Edinburgh Claudication Questionnaire described in ePROVIDE

  https://eprovide.mapi-trust.org/instruments/edinburgh-claudication-questionnaire

  To diagnose intermittent claudication in epidemiology surveys […] The Edinburgh Claudication Questionnaire: An Improved Version of The WHO/Rose Questionnaire for Use in Epidemiology Surveys. Journal of Clinical Epidemiology. 1992;45 (10): 1101–1109 (PubMed Abstract)

• #2 The Epidemiology of Peripheral Artery Disease | Clinical Gate

  https://clinicalgate.com/the-epidemiology-of-peripheral-artery-disease/

  Attempts to elucidate this association epidemiologically began with studies of patients having symptomatic PAD in the form of intermittent claudication. […] Peripheral artery disease is cross-sectionally associated with cardiovascular and cerebrovascular disease. […] After adjustment for known cardiovascular disease risk factors, PAD is associated with an increased risk of cardiovascular and cerebrovascular disease, morbidity, and mortality. […] With general aging of the population, it seems likely that PAD will be increasingly common in the future.

• #2 Peripheral arterial disease – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/431

  Most patients are asymptomatic. […] Long-term patency of lower-extremity revascularisation should be monitored with a surveillance programme. […] Death from a cardiac cause has a relative risk of 3 to 6 in patients with peripheral vascular disease.

• #2 Epidemiology – The Society for Vascular Medicine

  https://myperipheralarterydisease.com/health-care-providers/addressing-patients-with-suspected-and-confirmed-pad/epidemiology/

  Peripheral artery disease (PAD) is a global health problem and ranks among the top three causes of atherosclerotic cardiovascular disease, following coronary artery disease (CAD) and stroke. Recent data suggest that more than 200 million people have PAD worldwide. PAD is more common after the age of 50 years, and its prevalence increases with age, such that 1 in 5 patients by the age of 70 years have PAD. It affects men and women equally; however, the prevalence of symptomatic or severe disease is higher among men than women. At any given age, the prevalence of PAD is 2-fold higher in African Americans than among whites. Despite advances in contemporary therapy for atherosclerotic coronary disease, the prevalence of PAD continues to increase; such as, between 2000-2010 the prevalence of PAD has increased by ~15% in high-income countries and ~30% in low to middle income countries. Several observational analyses have highlighted the burden of PAD in the United States (US); for example, in a robust retrospective cohort analysis of 12 million adults in an insurance claims database in the US, the prevalence of PAD was 11%. In another analysis of primary care patients across the US, ~30% of patients who were 70 years of age or 50 years with a history of diabetes or smoking were reported to have PAD.

• #2 Epidemiology of peripheral artery disease | Health & Environmental Research Online (HERO) | US EPA

  https://hero.epa.gov/hero/index.cfm/reference/details/reference_id/6746884

  The major risk factors for PAD are similar to those for coronary and cerebrovascular disease, with some differences in the relative importance of factors. […] Smoking is a particularly strong risk factor for PAD, as is diabetes mellitus, and several newer risk markers have shown independent associations with PAD. […] PAD is strongly associated with concomitant coronary and cerebrovascular diseases. […] After adjustment for known cardiovascular disease risk factors, PAD is associated with an increased risk of incident coronary and cerebrovascular disease morbidity and mortality.

• #3 Pathophysiology of Intermittent Claudication in Peripheral Artery Disease

  https://www.jstage.jst.go.jp/article/circj/81/3/81_CJ-16-1286/_html/-char/ja

  The health implications of PAD derive from both its limb and cardiovascular manifestations. […] Risk reduction therapy continues to be underutilized in patients with PAD. […] Patients with PAD suffer from limb disability. […] Intermittent claudication is present in only 10-20% of PAD patients. […] Reduced walking function in patients with PAD is associated with poor clinical outcomes. […] Patients with PAD experience intermittent claudication, characterized as exertional leg pain that limits walking ability, and often times, disability. […] Robust evidence supports the utility of exercise training programs to improve walking function in patients with PAD. […] In patients with claudication, exercise is the most effective noninterventional approach to reducing leg symptoms. […] The available trial evidence indicates that exercise training and revascularization are complementary approaches to treating limb symptoms. […] An enhanced understanding of the pathophysiology of leg symptoms in PAD is critical for the development of novel therapeutic approaches.

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