Peripheral Arterial Disease Rising Among Americans

BY MITCHEL L. ZOLER

ORLANDO -- The prevalence of peripheral arterial disease in asymptomatic adults is increasing in the United States, according to data collected on a total of more than 5,000 people by the National Health and Nutrition Examination Survey during 1999-2004.

The spike in peripheral arterial disease (PAD) was especially dramatic in asymptomatic women, aged 40 or older, rising from 4.1% during 1999-2000 to 6.3% in 2003-2004, a jump of 54%, Dr. Andrew D. Sumner and his associates reported in a poster at the annual scientific sessions of the American Heart Association.

In contrast, the prevalence of PAD in asymptomatic men aged 40 or older fell slightly during the same 6-year period, from 3.3% in 1999-2000 to 2.8% in 2003-2004, a 15% decline.

A likely explanation for the sharp rise in women is an increasing prevalence of obesity, said Dr. Sumner, medical director of the Heart Station and cardiac prevention at Lehigh Valley Hospital in Allentown, Pa. The prevalence of obesity (a body mass index of 30 kg/m2 or greater) in women with PAD rose from 32% in 1999-2000 to 47% in 2003-2004.

"Public health initiatives to identify PAD in asymptomatic women and to reduce obesity should be undertaken," Dr. Sumner and his associates said in their poster.

The sharp rise in PAD in women helped to drive an increase seen in all Americans during the period studied. Overall, PAD prevalence rose from 3.7% in 1999-2000 to 4.6% in 2003-2004, a 24% jump.

'PUBLIC HEALTH INITIATIVES TO IDENTIFY PAD IN ASYMPTOMATIC WOMEN AND TO REDUCE OBESITY SHOULD BE UNDERTAKEN.'

Other subgroups that showed notable rises in PAD were Mexican Americans, in whom PAD prevalence jumped from 2.9% in 1999-2000 to 5.1% in 2003-2004, a rise of 76%, and non-Hispanic blacks, who had a 7.5% rate in 1999-2000 and a 10.8% prevalence in 2003-2004, a 44% increase.

In contrast, PAD prevalence was fairly flat in non-Hispanic whites, rising from 3.5% to 4.1%, an increase of 17%.

The analysis also showed a clear link between older individuals and an increased prevalence of PAD.

The prevalence of PAD was 1%-2% in asymptomatic people aged 40-49, 2%-3% in those aged 50-59, 4%-8% in people aged 60-69, and about 15% in people aged 70 or older.

Three of these age subgroups showed a clear increase in prevalence during the period studied. Among those aged 40-49, the prevalence rose from 0.9% to 2.0%, a 122% increase. Among people aged 50-59, prevalence rose from 1.8 to 2.8%, a 56% increase.

And in people aged 60-69 the prevalence of PAD was 4.2% in 1999-2000, 7.5% in 2001-2002, and 6.1% in 2003-2004, showing a 45% rise in prevalence between 1999-2000 and 2003-2004. The prevalence rate among people aged 70 or older held fairly steady at close to 15% during all three time periods.

The National Health and Nutrition Examination Survey (NHANES) is run by the Centers for Disease Control and Prevention, which in 1999 began conducting serial national surveys every 2 years (each NHANES prior to 1999 each ran longer than 2 years).

The 1999-2000, 2001-2002, and 2003-2004 NHANES consisted of a total of 5,376 asymptomatic people aged 40 or older with no history of cardiovascular disease. PAD was identified in people who had an ankle-brachial index of less than 0.9