Peripheral Arterial Disease Significantly Affects People Over 60 Years Old
Yes, peripheral arterial disease (PAD) significantly affects people over 60 years old, with prevalence dramatically increasing with age, reaching nearly 60% in those aged 85 years and older. 1
Epidemiology of PAD in Older Adults
The prevalence of PAD shows a clear age-related pattern:
- Global prevalence is approximately 1.52% overall, but increases dramatically with age 1
- In people aged 80-84 years, prevalence reaches 14.91% 1
- The Rotterdam study found PAD present in 10% of subjects aged 55-59 years, increasing to nearly 60% in those ≥85 years 1
- PAD affects approximately 8.5 million people in the US and 230 million worldwide, affecting up to 20% of people aged 80 years and older 2
- American Family Physician reports PAD affects 12% to 20% of Americans 60 years and older 3
Age-Specific Incidence and Prevalence
The Framingham Heart Study provides compelling evidence of the age-related increase in PAD:
- Annual incidence of intermittent claudication for ages 30-44 years: 6 per 10,000 men and 3 per 10,000 women
- Annual incidence for ages 65-74 years: 61 per 10,000 men and 54 per 10,000 women 1
This represents a 10-fold increase in incidence with advancing age.
Gender Differences in Older Adults with PAD
Interestingly, while PAD is generally more common in men at younger ages, the gender distribution shifts with age:
- In the general population, PAD is twice as prevalent among men as among women 1
- However, in the oldest age groups (80-84 years), PAD prevalence is higher in females (18.03%) than in males (10.56%) 1
Clinical Presentation in Older Adults
PAD presentation in older adults has important distinctions:
- Only about 10% of patients with PAD experience classic intermittent claudication 3
- 50% of patients have leg symptoms that differ from classic claudication 3
- 40% have no leg symptoms at all (asymptomatic) 3
- Among older persons with PAD, 30-50% are asymptomatic, and only 5-19% have classic claudication 1
- The high proportion of asymptomatic older PAD patients likely relates to low physical activity levels in this population 1
Risk Factors and Comorbidities
Older adults with PAD typically have multiple risk factors:
- Hyperlipidemia, hypertension, diabetes mellitus, chronic kidney disease, and smoking are significant risk factors 3
- The presence of three or more factors confers a 10-fold increase in PAD risk 3
- Smoking and diabetes are particularly potent risk factors for PAD in older adults 1
- PAD often coexists with other cardiovascular diseases - among persons 60-90 years in chronic care facilities, 79% of patients with PAD also had clinical coronary heart disease and/or prior stroke 1
Diagnostic Considerations in Older Adults
The ankle-brachial index (ABI) remains the primary screening tool:
- ABI <0.9 suggests PAD with a sensitivity of 79-95% and specificity ≥95% 1
- However, an ABI >1.3 is more common in older PAD patients due to calcified, non-compressible arteries 1
- Given the high prevalence of asymptomatic PAD in older adults, those with claudication or atypical leg symptoms, as well as those with known coronary heart disease or prior stroke should undergo ABI testing 1
Clinical Implications
The impact of PAD in older adults is substantial:
- PAD is associated with approximately twice the rate of all-cause mortality, cardiovascular mortality, and major coronary events at 10-year follow-up compared to people without PAD 2
- In older patients with PAD, the presence of geriatric syndromes such as frailty, sarcopenia, malnutrition, and functional decline may obscure symptoms until PAD reaches an advanced state 1
- Low ABI is a strong and graded independent predictor of mortality and was the best predictor of death, stroke, or myocardial infarction in older patients in primary care settings 1
PAD represents a significant health concern for people over 60 years old, with prevalence increasing dramatically with age and carrying substantial implications for morbidity, mortality, and quality of life.