Trends and Potential Risk Factors of Lower Extremity Peripheral Arterial Disease: Results from the Global Burden of Disease Study 2021.

Introduction: Lower extremity peripheral arterial disease (LEPAD), causing reduced limb blood flow and significant morbidity, is a major global health concern. Understanding its burden and attributable risk factors is crucial for public health planning. The aim of this study was to quantify the global, regional, and national burden of LEPAD and disability-adjusted life years (DALYs) lost attributable to key risk factors from 1990 to 2021. Methods: This analysis utilized data from the Global Burden of Disease Study 2021. It employed multisource data and advanced statistical modeling to estimate LEPAD prevalence, incidence, mortality, DALYs, and risk factor attribution across 204 countries and territories. Results: In 2021, there were 113.7 million LEPAD survivors and 10.0 million new cases globally, with females comprising 67.0% of prevalent cases. LEPAD caused 67,000 deaths and 1.5 million DALYs. Six key risk factors accounted for most attributable DALYs: high fasting plasma glucose (36.06%), kidney dysfunction (28.64%), smoking (25.04%), hypertension (21.72%), lead exposure (15.05%), and high body mass index (BMI, 8.75%). Low- and middle-income countries bore a disproportionate burden (68.8% of incident cases, 60.9% of DALYs). While global incidence and mortality modestly declined since 1990, increases occurred in lower-middle and low socio-demographic index regions. Conclusion: LEPAD imposes a substantial global burden, disproportionately affecting females and populations in low-resource settings. Modifiable metabolic (glucose, kidney function, BMI, hypertension) and behavioral (smoking) risks dominate. Targeted interventions, especially in high-burden regions experiencing increasing trends, are urgently needed to mitigate LEPAD-related morbidity and mortality. Future research should focus on effective interventions and healthcare access barriers.