ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Cardiovascular Epidemiology and Prevention
Global, regional, and national burden of lower extremity peripheral arterial disease and its attributable risk factors from 1990 to 2021: an analysis for the Global Burden of Disease Study 2021
Meng Zhang
Guodong Wang
Xuebin Cui
Yuanmin Pei
Yidu Central Hospital of Weifang, Weifang, China
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Abstract
Background Lower extremity peripheral artery disease (LEPAD) is an atherosclerotic disorder characterized by stenosis or occlusion of the arteries supplying the lower limbs. A systematic analysis of global epidemiological trends and risk factors for LEPAD is essential for informing public health policies and optimizing disease management strategies. Methods Using data from 1990 to 2021, this study examined temporal trends by age, sex, and region, and evaluated the association between LEPAD-related disability-adjusted life years (DALYs) and the Socio-Demographic Index (SDI). The non-fatal disease burden was modeled using DisMod-MR 2.1, while mortality risk was analyzed with the Cause of Death Ensemble model (CODEm). Results In 2021, global prevalent cases of LEPAD totaled 113.7 million, with an age-standardized prevalence rate (ASPR) of 1,326.5 per 100,000—representing a 12.3% decline since 1990. The age-standardized incidence rate (ASIR) was 115.4, mortality rate (ASMR) 0.8, and DALY rate (ASDR) 18.6 per 100,000, corresponding to reductions of 11.4%, 35.9%, and 30.1%, respectively, since 1990. Leading risk factors contributing to LEPAD-related DALYs included high fasting plasma glucose (36.1%), kidney dysfunction (28.6%), smoking (25.0%), high BMI (19.3%), and high systolic blood pressure (13.1%), with significant variations observed by sex and age. Conclusion Based on GBD 2021 data, although age-standardized rates of LEPAD declined globally between 1990 and 2021, the absolute number of cases remains substantial. Key modifiable risk factors include smoking, hyperglycemia, hypertension, kidney dysfunction, and high BMI.
Summary
Keywords
DALYs, GBD 2021, lower extremity peripheral artery disease, risk factor, SDI
Received
03 July 2025
Accepted
28 January 2026
Copyright
© 2026 Zhang, Wang, Cui and Pei. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Yuanmin Pei
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