Jacksonville Family Medicine Residency Program, Naval Hospital Jacksonville, FL ; Uniformed Services University of the Health Sciences, Bethesda, MD ; Naval Hospital Naples, Italy dustinksmith@yahoo.com
The authors reported no potential conflict of interest relevant to this article.
The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Uniformed Services University of the Health Sciences, Department of Defense, or the United States government.
Genetics. A study performed by the National Heart Lung and Blood Institute suggested that genetic correlations between twins were more important than environmental factors in the development of PAD.11
Smoking. Most population studies show smoking to be the greatest modifiable risk factor for PAD. An analysis of the NHANES data yielded an odds ratio (OR) of 4.1 for current smokers and of 1.8 for former smokers.1 Risk increases linearly with cumulative years of smoking.1,2,9,10
Diabetes is another significant modifiable risk factor, increasing PAD risk by 2.5 times.2 Diabetes is also associated with increases in functional limitation from claudication, risk for acute coronary syndrome, and progression to amputation.1
Hypertension nearly doubles the risk for PAD, and poor control further increases this risk.2,9,10
Chronic kidney disease (CKD). Patients with CKD have a progressively higher prevalence of PAD with worsening renal function.1 There is also an association between CKD and increased morbidity, revascularization failure, and increased mortality.1
Two additional risk factors that are less well understood are dyslipidemia and chronic inflammation. There is conflicting data regarding the role of individual components of cholesterol and their effect on PAD, although lipoprotein (a) has been shown to be an independent risk factor for both the development and progression of PAD.12 Similarly, chronic inflammation has been shown to play a role in the initiation and progression of the disease, although the role of inflammatory markers in evaluation and treatment is unclear and assessment for these purposes is not currently recommended.12,13
