Risk Factors for Peripheral Vascular Disease
The major risk factors for peripheral vascular disease (PVD) include tobacco smoking, hypertension, dyslipidemia, diabetes mellitus, advanced age, and physical inactivity, with smoking being a particularly powerful risk factor for atherosclerosis of the aorta and lower limbs. 1
Major Modifiable Risk Factors
Well-Documented Risk Factors
- Tobacco smoking: Particularly powerful risk factor for atherosclerosis of the aorta and lower limbs 1
- Hypertension: Present in 87% of PVD patients 2
- Dyslipidemia:
- Diabetes mellitus: Increases risk of PVD, occurs earlier and is often more severe and diffuse 5
- Physical inactivity: Contributes to disease progression 1
- Obesity: Present in approximately 24% of PVD patients 2
Non-Modifiable Risk Factors
- Advanced age: PVD prevalence increases dramatically with age, affecting nearly 20% of adults over 70 years 1
- Male sex: Men are affected slightly more than women 1, 4
- Family history of premature cardiovascular disease 3
- Genetic factors 3
- Race/ethnicity: Variations in prevalence across different ethnic groups 3
Hierarchy of Risk Factors
Research has established the following hierarchy of cardiovascular risk factors as predictors of PVD (in order of importance) 2:
- Hypertension
- Cardiovascular disease
- Hyperlipidemia
- Diabetes
- Tobacco use
- Obesity
- Stroke
Special Considerations for Diabetic Patients
Patients with diabetes have unique characteristics regarding PVD:
- PVD occurs earlier and is often more severe and diffuse in diabetic patients 5
- Key pathophysiological factors in diabetic arteriopathy include:
- Endothelial dysfunction
- Vascular smooth muscle cell dysfunction
- Inflammation
- Hypercoagulability 5
- Peripheral neuropathy can mask symptoms of PVD, leading to delayed diagnosis 1
Clinical Significance
PVD is not only a localized disease but also a marker for systemic atherosclerosis:
- Patients with PVD have a 3-fold increased risk of myocardial infarction, stroke, and vascular death 1
- PVD is associated with decreased quality of life and functional capacity 1
- Despite its significance, PVD is largely underdiagnosed and undertreated 5
Risk Assessment
The presence of multiple risk factors significantly increases the likelihood of developing PVD:
- Patients with PVD have an average of 3.2 ± 1.3 risk factors 2
- Risk factor burden correlates with disease severity 2
- Screening with ankle-brachial index (ABI) is recommended for high-risk individuals, including:
- Adults aged 70 years or older
- Adults with a 10 pack-year smoking history
- Patients with diabetes 1
Understanding these risk factors is crucial for early identification of at-risk individuals and implementation of appropriate preventive strategies to reduce morbidity and mortality associated with PVD.