Global epidemiology of lower extremity artery disease in the 21st century (2000–21): a systematic review and meta-analysis

Abstract

Abstract Aims The epidemiology of lower extremity artery disease (LEAD) is evolving. This meta-analysis of aggregate data aimed to (i) determine the global prevalence of LEAD and by regions in the 21st century and (ii) update the associated risk factors in this period. Methods and results A systematic literature review was performed through PubMed, Cochrane, Scopus, Science Direct, and Google Scholar databases, restricted to general population studies between January 2000 and September 2021, with LEAD defined by a low (</≤0.90) ankle–brachial index. The Newcastle–Ottawa Scale was used to evaluate the quality of the articles before data extraction. Due to high heterogeneity, the random effect model was applied to this meta-analysis. Among 1418 references, 38 studies (127 961 participants) were retained. The global prevalence in adults, mostly ≥40 years, was estimated at 9.7% [95% confidence interval (CI): 7.1–12.4], higher in women (10.2%) than in men (8.8%), increasing sharply with age. The highest prevalence was found in South–Central Asia (14.5%) and the lowest in North America (5.6%). Significant associations were found between LEAD and current [odds ratio (OR) = 1.9, 95% CI: 1.4–2.5] and past smoking (OR = 1.6, 95% CI: 1.3–1.9) and between LEAD and diabetes (OR = 2.3, 95% CI: 2.0–2.8). Hypertension was significantly associated with LEAD (OR = 2.3, 95% CI: 1.9–2.8) and in particular in South America (OR = 4.0). Obesity (OR = 1.5, 95% CI: 1.2–1.8) and hypercholesterolaemia ≥200 mg/dL (OR = 1.9, 95% CI: 1.3–2.8) were also significantly associated with LEAD. Conclusion This meta-analysis highlights a currently high prevalence of LEAD worldwide, with substantial differences in global regions and between sexes. The strongest associations were found with metabolic risk factors.