What are the risk factors for peripheral arterial disease (PAD)?

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Last updated: February 18, 2026 • View editorial policy

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Risk Factors for Peripheral Vascular Disease

The major risk factors for peripheral arterial disease (PAD) are smoking, diabetes mellitus, dyslipidemia, and hypertension, with smoking being the most powerful risk factor—particularly stronger for PAD than for coronary artery disease. 1

Traditional Atherosclerotic Risk Factors

Smoking

  • Cigarette smoking is the most potent modifiable risk factor for PAD, increasing risk 2-6 fold and appearing in the history of over 80% of PAD patients 2
  • Smoking is 2-3 times more likely to cause PAD than coronary artery disease, demonstrating a dose-dependent relationship 1, 2
  • The risk is so strong that in most epidemiological studies, patients with claudication have had a smoking history at some point in their lives 1
  • Smoking cessation produces rapid benefit, with PAD incidence declining to match non-smokers after just 1 year of abstinence 1

Diabetes Mellitus

  • Diabetes increases PAD risk 2-4 fold overall, with the Framingham Heart Study showing claudication risk increased 3.5-fold in men and 8.6-fold in women 2
  • The risk is proportional to both diabetes severity and duration, making it particularly important for severe manifestations like gangrene and ulceration 1, 2
  • Diabetic patients with PAD face a 7-15 times higher amputation risk compared to non-diabetics with PAD 2
  • The presence of neuropathy in diabetic patients with vascular disease substantially increases the risk of foot ulceration and limb-threatening complications 2

Dyslipidemia

  • High total cholesterol and low HDL cholesterol are independently associated with increased PAD risk 1
  • The ratio of total cholesterol to HDL cholesterol is the lipid measure most strongly related to PAD development 1
  • Hyperlipidemia is present in 88% of PAD patients versus 60% of those without PAD 3

Hypertension

  • Most epidemiological studies demonstrate an association between hypertension and PAD presence 1
  • Hypertension prevalence reaches 90% in PAD patients versus 76% in those without PAD 3
  • One study found hypertension associated with a relative risk of 2.8 for developing PAD 1
  • Both increased systolic and diastolic blood pressure correlate with low ankle-brachial index (<0.90) 1

Additional Risk Factors

Age

  • PAD prevalence increases dramatically with age, affecting 8-12% of adults aged 60 years and older 4
  • Prevalence rises to approximately 29% among individuals aged ≥70 years 5
  • Subclavian artery stenosis increases from 1.4% in those <50 years to 2.7% in those >70 years 1

Chronic Kidney Disease

  • Chronic kidney disease is a significant risk factor for PAD development 4
  • The presence of three or more risk factors confers a 10-fold increase in PAD risk 4

Polyvascular Disease Considerations

Coexisting Atherosclerotic Disease

  • PAD and coronary artery disease frequently coexist due to shared atherosclerotic pathophysiology, with 63% of PAD patients having concomitant coronary disease 2, 3
  • The presence of disease at one vascular site increases the frequency of disease at other sites, particularly in elderly patients where overlap of coronary, cerebrovascular, and lower extremity disease is especially high 1
  • Stroke prevalence is 36% in PAD patients versus 11% in those without PAD 3
  • Cardiovascular ischemic events are more frequent than ischemic limb events in PAD patients, emphasizing the systemic nature of the disease 2

Clinical Implications for Risk Assessment

Screening Recommendations

  • In patients with multiple risk factors (smoking, diabetes, coronary disease), PAD screening is recommended even without symptoms since up to 50% of PAD patients are asymptomatic 2, 5
  • The ankle-brachial index (ABI) is the most cost-effective screening tool, though arterial calcification in diabetic patients may falsely elevate ABI measurements requiring alternative diagnostic approaches 2

Risk Factor Clustering

  • Current smoking prevalence is 31% in PAD patients versus 12% in those without PAD, with an additional 40% being ex-smokers 3
  • The clustering of multiple risk factors is common, with diabetes present in 45% of PAD patients versus 22% without PAD 3

Critical pitfall: Approximately 40% of PAD patients have no leg symptoms, so risk assessment and screening decisions must be based on risk factor profiles and objective testing rather than symptoms alone. 6

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

2
Guideline

Relationship Between PVD and PAD in Patients with Risk Factors

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

5
Guideline

Peripheral Artery Disease and Edema

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

6
Guideline

Peripheral Vascular Disease Management

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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