Epidemiology and prevention of peripheral arterial disease

The prevalence of peripheral arterial disease (PAD) is underestimated. PAD is a serious risk factor for cardiovascular morbidity and mortality. The disease is seldom localized only in the legs and in 90% of the patients caused by atherosclerosis. The prevalence of symptomatic PAD is both in women and men aged greater than or equal to 55 years 4.5%. However, the prevalence of asymptomatic PAD is > 20%. The 5-year mortality rate in male patients with PAD may be as high as 5-17%. The life expectancy is reduced by 10 years. The main causes of death are coronary and cerebral vascular diseases. These facts demonstrate a high rate of coexistence of PAD, coronary artery disease and cerebral vascular diseases. The guide lines for the treatment of the risk factors for the development of PAD underline their importance. Smoking cessation and antiplatelet therapy already in asymptomatic patients should be accompanied by nonpharmacological as well as pharmacological therapy of diabetes mellitus (fasting blood sugar 80-120 mg%, HbA(1c), <7%, hyperlipidemia LDL cholesterol < 100 mg%) and arterial hypertension (< 130/85 mmHg). Furthermore, the importance of hyperhomocysteinemia and hyperfibrinogenemia are well known. However, the preventive efficacy of specific therapies could not yet be defined. Furthermore, additional therapeutic strategies as exercise and weight reduction in obese patients should be mentioned.