Key Insights On Assessing The Risk Factors For PAD

Anthony Yung, DPM, and Khurram Khan, DPM

What Influence Do Age And Race Have?
Age and race play a role in the development of PAD. The National Health and Nutrition survey in the United States found the highest incidences of PAD in African-Americans at 7.8 percent, which was nearly twice the incidence (4.4 percent) among Caucasians. The incidence of PAD increases significantly with age but not uniformly.
The incidence rises from 0.9 percent with people in their 40s to 4.7 percent for people in their 60s. When patients are over the age of 70, the incidence of PAD rises sharply to 14.5 percent.

What You Should Know About Other PAD Risk Factors
Hypertension is a known risk factor for cardiovascular disease. Its effects on PAD are weaker than diabetes and smoking, and researchers have associated hypertension with a two- to threefold increased risk of claudication.11 The effect of hypertension control on the outcome of PAD has not been established. The United Kingdom Prospective Diabetes Study (UKPDS) did not show a reduction in amputation risk. There is a demonstrated reduction in cardiovascular risk.
Therefore, the ADA continues to recommend aggressive hypertension control to reduce the associated cardiovascular risk (140/90 mmHg in non-diabetics and 130/80 mmHg in patients with diabetes). There may be a role for ACE inhibitors for cardio-protective effects.8
Elevated levels of total cholesterol, LDL cholesterol, triglycerides and lipoprotein are independent risk factors for PAD development. One study found elevated total cholesterol levels (> 270 mg/dl) increased the risk by a factor of two.12 Lowering cholesterol decreases cardiovascular events for patients with diabetes. There is also data demonstrating a reduction in cardiovascular complications with the treatment of dyslipidemia. Although there are no direct data on treating dyslipidemia in patients with both diabetes and PAD, published guidelines recommend a target LDL cholesterol level of < 70 mg/dl based on a reduction of cardiovascular risk.13
Researchers have also reported that cardiovascular markers of risk such as C-reactive protein, homocysteine and fibrinogen are increased in PAD. Elevated levels of C-reactive protein, a marker of systemic inflammation, have been linked to up to a twofold increase in developing PAD.14
Elevated levels of homocysteine are associated with a two- to threefold increased risk for developing atherosclerotic arterial disease. The role of homocysteine remains unknown. Several studies have demonstrated that the use of folic acids and other lowering agents has not affected change in macrovascular disease and suggest that it may be a marker rather than a cause of atherosclerosis.15

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