Peripheral artery disease (PAD) might not be immediately fatal or significantly affect quality of life, but it can quickly progress into a grave medical issue if it is not diagnosed and managed in a timely manner. Early diagnosis has many advantages, from better long-term quality of life to reduced mortality and decreased costs of treatment.

Cardiovascular diseases (CVDs), of which PAD is also a part, are the leading cause of mortality worldwide and in 2016 alone accounted for more than 17.9 million deaths (31% of all deaths globally), about 85% of which were due to heart attack and stroke [1].
How many of those are due to PAD is difficult to estimate, let alone calculate, at least on a global level, as this insidious disease often goes undiagnosed despite being comorbid to many lethal CVDs, like stroke and coronary artery disease (CAD).
For example, PAD is quite common in those with CAD with prevalence between 22 and 42%; patients with both diseases fare worse (in terms of quality of life and mortality) than those with only CAD [2,3,4,5]. Association with the biggest killer amongst the CVDs is just one of the reasons for preventive screening for PAD – indicative connection with general cardiovascular health being the other and most important one.
Does screening for Peripheral Arterial Disease (PAD) lead to reduced morbidity and mortality from PAD?
The asymptomatic nature of PAD makes timely and accurate diagnosis only on the basis of a physical examination a tall order and misdiagnosis is common, especially if performed by a less experienced examiner [6]. Fortunately, there are more advanced diagnostic methods and tools with high accuracy and specificity, specifically the ABI (ankle-brachial index) measurement, which lends itself to screening of large numbers of potential patients [7]. However, for the screening processes to be cost-effective, clinicians should first identify at-risk individuals on the basis of well-established risk factors for PAD.
The most prominent risk factor for PAD (and atherosclerosis in general) is tobacco smoking; it dramatically increases the incidence of PAD in men, while female smokers are even worse affected as they are at a 20-fold increased risk (over a 13-year period) in comparison with non-smokers [8,9].
Another one is diabetes since the most common symptom of PAD (intermittent claudication) and one that greatly affects the patient’s quality of life (diminished physical activity) is 3.5 times more prevalent in male diabetics and 8.6 times more in female diabetics than in the non-diabetic populations [10]. Lastly, hyperlipidaemia, hypertension and weight (obesity) round the list of risk factors with emphasis on obesity, which contributes to a 3 to 5-fold increase in incidence of PAD [11,12,13].
Preventive screening of patients for PAD (on the basis of the ABI measurement) has the benefit of improving the accuracy of cardiovascular risk prediction beyond the FRS (Framingham risk score) and can, indirectly, predict the risk of total and cardiovascular mortality [14].
Even more, timely identification of PAD has a positive effect on morbidity. One study showed that early identification of PAD on the basis of ABI and the presence of intermittent claudication and subsequent lifestyle change intervention significantly improved the frequency and time of physical activity (important part of conservative management of PAD due to its antiatherogenic effect) and even contributed to smoking cessation in some patients who participated in the study [15]. A study conducted in Germany and encompassing elderly individuals demonstrated the improvement of cardiovascular risk factors after 2 years of treatment after an initial diagnosis of PAD on the basis of ABI measurement [16].
In short, screening for PAD on the basis of ABI has many benefits, with special consideration for individuals in at-risk groups for PAD.
[1] Cardiovascular diseases (CVDs) > https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)
[2] The prevalence of peripheral arterial disease in high risk subjects and coronary or cerebrovascular patients > https://www.ncbi.nlm.nih.gov/pubmed/17626985
[3] Lower extremity peripheral arterial disease in hospitalized patients with coronary artery disease > https://journals.sagepub.com/doi/abs/10.1191/1358863x03vm506ra
[4] Peripheral artery disease in patients with coronary artery disease > https://www.ncbi.nlm.nih.gov/pubmed/7658111
[5] Prior peripheral arterial disease and cerebrovascular disease are independent predictors of adverse outcome in patients with acute coronary syndromes: are we doing enough? Results from the Orbofiban in Patients with Unstable Coronary Syndromes-Thrombolysis In Myocardial Infarction (OPUS-TIMI) 16 study > https://www.ncbi.nlm.nih.gov/pubmed/12679757
[6] Peripheral pulse palpation: an unreliable physical sign > https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2497570/
[7] Comparison of AnkleBrachial Index (ABI) Measurement between a New Oscillometric Device (MESI ABPI MD®) and the Standard Doppler Method in the Diagnosis of Lower Extremity Arterial Disease (LEAD) > http://www.heraldopenaccess.us/fulltext/Non-Invasive-Vascular-Investigation/Comparison-of-Ankle-Brachial-Index-ABI-Measurement-between-a-New-Oscillometric-Device-MESI-ABPI-Md-and-the-Standard-Doppler-Method.pdf
[8] Associations between conventional cardiovascular risk factors and risk of peripheral artery disease in men > https://www.ncbi.nlm.nih.gov/pubmed/23093164
[9] Smoking, smoking cessation, [corrected] and risk for symptomatic peripheral artery disease in women: a cohort study > https://www.ncbi.nlm.nih.gov/pubmed/21646555
[10] Peripheral Arterial Disease in Patients With Diabetes > https://www.sciencedirect.com/science/article/pii/S0735109705028627?via%3Dihub
[11] Peripheral Artery Disease: Current Insight Into the Disease and Its Diagnosis and Management > https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2894725/
[12] Hypertension in peripheral arterial disease > https://www.ncbi.nlm.nih.gov/pubmed/15579058
[13] Associations of Obesity With Incident Hospitalization Related to Peripheral Artery Disease and Critical Limb Ischemia in the ARIC Study > https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6201405/
[14] Ankle Brachial Index Combined with Framingham Risk Score to Predict Cardiovascular Events and Mortality: A Meta-analysis > https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2932628/
[15] Improving maximum walking distance in early peripheral arterial disease: Randomised controlled trial > https://www.sciencedirect.com/science/article/pii/S0004951414601665
[16] [Peripheral arterial disease: predictors and treatment intensity. Two-years of data from the population-based INVADE project] > https://www.ncbi.nlm.nih.gov/pubmed/18302095