One-fifth of the U.S. population aged 40 years and older has lower extremity disease, the Centers for Disease Control and Prevention reported.
In the 1999–2002 National Health and Nutrition Examination Survey, about 5% of adults aged 40 and above had peripheral arterial disease (PAD), 13% had peripheral insensate neuropathy (PN), and 4% reported a foot ulcer or were observed to have a current foot lesion or toe/foot amputation. Overall, 18.6% had one or more of these lower extremity disease (LED) conditions, the CDC said (MMWR 2005;54:1158–60).
The majority of these cases—including two-thirds of those with PAD and three fourths with PN—were asymptomatic. About one-fourth of the cases of both conditions were severe, defined as an ankle-brachial blood pressure index of less than 0.7 in either leg with PAD, or three or more insensate areas with PN.
The prevalence of LED was about twice as high in people diagnosed with diabetes as in those without, and 53% of the diabetics were symptomatic, compared with 31% of nondiabetics. Among individuals with PN, 42% of the diabetics were symptomatic versus 21% of nondiabetics, whereas one-third of the PAD group was symptomatic regardless of diabetes status.
Not surprisingly, the prevalence of LED increased with age, from 12.3% among those aged 40–59 years to 26.2% of 60- to 74-year-olds, to 40.8% of those aged 75 and older.
The conditions also were more common overall in men than in women (23% vs. 17%) and were higher among blacks (27%) than either whites (19%) or Mexican Americans (21%).
Diabetics had higher LEDrates than nondiabetics in all age, sex, and racial/ethnic groups, the CDC noted.
In 2003, the American Diabetes Association issued guidelines for the diagnosis and management of PAD, including a recommendation that an ankle-brachial index be obtained in all diabetic patients over age 50 (Diabetes Care 2003;26:3333–41).