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4.1. Amplifiers of Cardiovascular and Limb-Related Risk in
Patients With PAD
COR LOE
Recommendation
1 C-EO
1. In the evaluation of patients with PAD, clinicians should
assess for and incorporate the presence of PAD-related
risk amplifiers (Table 9) when developing patient-focused
treatment recommendations.
4. Special Considerations in PAD: Risk Amplifiers, Health
Disparities, and PAD in Older Patients
Table 9. PAD-Related Risk Amplifiers
Risk Factor Epidemiology
Data Supporting Amplified Risk
(MACE, MALE, or Both)
Older age (ie,
≥75 y)
See Section 4.3,
"Considerations
in Management
of PAD in Older
Patients"
See Section 4.3, "Considerations in
Management of PAD in Older Patients"
Diabetes (see
Section 5.5,
"Diabetes
Management for
PAD")
Among patients
with diabetes, up
to 20% of patients
>40 y of age, 30%
>50 y of age, and
70% >70 y of age
have PAD.
Diabetes is associated with a higher risk of all-
cause death (HR, 1.35 [95% CI, 1.15–1.60])
and MACE (HR, 1.47 [95% CI, 1.23–1.75]).
Among patients undergoing endovascular
revascularization, those with diabetes presented
more commonly with CLTI: 46.1% versus
25.5% for those without diabetes (P<0.001).
Diabetes is associated with a greater risk of
lower extremity amputation (adjusted HR,
5.48 [95% CI, 4.16–7.22]).
Ongoing smoking
and use of other
forms of tobacco
(see Section
5.4, "Smoking
Cessation for
PAD")
80%–90%
of patients
revascularized
for severe limb
symptoms are
current smokers
(see Section 5.4
for developing
symptomatic
PAD in current
smokers).
Ongoing smoking is associated with
a significant increase in PAD-related
hospitalizations, revascularization procedures,
and health care costs.
e 5-y mortality rate with active smoking and
chronic symptomatic PAD is 40%–50%.
