Peripheral arterial disease: morbidity and mortality implications.

Peripheral arterial disease (PAD) has been estimated to reduce quality of life in approximately 2 million symptomatic Americans,1 and millions more Americans without claudication are likely to suffer PAD-associated impairment.2 PAD is a strongly age-dependent condition that contributes significantly to morbidity and healthcare expenditures in the elderly: There are 413 000 discharges per year with chronic PAD, 88 000 hospitalizations involving lower-extremity arteriography, and 28 000 discharges citing embolectomy or thrombectomy of lower-limb arteries.3 Figures for prevalence of asymptomatic PAD are several-fold higher. These figures were based on National Hospital Discharge Survey and National Vital Statistics System 1985 to 1987 US data; numbers of procedures had increased in the prior decade3 and are likely to have increased in the intervening years as the population continues to age. Even though few deaths were directly attributed to PAD, PAD has potent mortality implications. Although symptomatic disease directly affects functional capacity and quality of life by restricting ambulation, asymptomatic disease is also important, not only because it may augur risk of future compromised ambulation, lowerextremity ulcers, or need for vascular surgery or amputation, but perhaps most importantly because asymptomatic and symptomatic PAD are consistent and powerful independent predictors of coronary artery disease (CAD) and cerebrovascular disease (CBVD) events and mortality. The evidence relating PAD to prevalent and incident cardiac and cerebrovascular disease (CCVD) forms the focus of the present report.