Lifetime Risk of Lower-Extremity Peripheral Artery Disease Defined by Ankle-Brachial Index in the United States.
Level 3 - non-randomized controlled study
Markov simulation model based on pooled data from six observational community cohorts and vital statistics
PubMed 31500474 · doi:10.1161/JAHA.119.012177
What was done
Data from 6 US community-based cohorts and vital statistics were used to estimate the age-specific prevalence and incidence of peripheral artery disease (PAD, defined as an ankle-brachial index < 0.90) from birth to age 80 for White, Black, and Hispanic men and women. A Markov Monte Carlo simulation in a simulated cohort of 100,000 individuals was used to model lifetime risk, and odds ratios for traditional atherosclerotic risk factors were incorporated into a calculator for residual lifetime risk.
What was found
Over an 80-year horizon, lifetime risks of PAD were 30.0% in Black men, 27.6% in Black women, ≈19% in White men and women, and ≈22% in Hispanic men and women. A 9% cumulative risk was reached by age 60 in Black individuals, compared to ≈70 years for White and Hispanic individuals. Residual lifetime risk within the same race/ethnicity varied 3.5- to 5-fold by risk factors (e.g., in 45-year-old Black men, risk was 19.9% without smoking, diabetes, or cardiovascular disease history versus 70.4% when all three were present).
Why it matters
This study provides the first lifetime risk estimates for PAD in the United States, revealing substantial racial disparities in PAD burden and showing that Black adults reach equivalent disease risk approximately a decade earlier than White and Hispanic adults.
Limits
The total sample size of the original cohorts is not reported in the abstract. Results rely on simulation modeling rather than direct lifetime observation. PAD was defined solely by an ankle-brachial index < 0.90, which may miss symptomatic disease or cases with non-compressible arteries.
Cited by
- context Approximately 10% to 15% of Americans have peripheral artery disease.