Risk factor The illustration shows how<unk>  can affect<unk> es in the legs. Figure A shows a normal<unk>  with normal blood flow. The inset image shows a cross-section of the normal<unk> . Figure B shows an<unk>  with plaque buildup that is partially blocking blood flow. The inset image shows a cross-section of the narrowed<unk> . Factors contributing to increased risk of<unk>  are the same as those for atherosclerosis. These include age, sex, and ethnicity.<unk>  is two times as common in males as females. In terms of ethnicity,<unk>  is more common in people of color compared to the white population in a 2:1 ratio. The factors with the greatest risk association are hyperlipidemia, hypertension, diabetes mellitus, chronic kidney<unk> , and smoking. Presenting three of these factors or more increases the risk of developing<unk>  ten-fold. * Smoking – tobacco use in any form is the single greatest risk factor of<unk>  internationally. Smokers have up to a 10-fold increase in risk of<unk>  in a dose-response relationship. Exposure to second-hand smoke has also been shown to promote changes in the lining of blood vessels (endothelium), which can lead to atherosclerosis. Smokers are 2–3 times more likely to have lower extremity<unk>  than coronary<unk><unk> . Greater than 80%-90% of patients with lower extremity<unk> <unk> al<unk>  are current or former smokers. The risk of<unk>  increases with the number of cigarettes smoked per day and the number of years smoked. * High blood sugar – Diabetes mellitus is shown to increase risk of<unk>  by 2–4 fold. It does this by causing endothelial and smooth-muscle cell dysfunction in<unk> <unk> es. The risk of developing lower extremity<unk> <unk> al<unk>  is proportional to the severity and duration of diabetes. * High blood cholesterol – Dyslipidemia, which is an abnormally high level of cholesterol or fat in the blood. Dyslipidemia is caused by a high level of a protein called low-density lipoprotein (LDL cholesterol), low levels of high-density lipoprotein (HDL cholesterol), elevation of total cholesterol, and/or high triglyceride levels. This abnormality in blood cholesterol levels have been correlated with accelerated<unk> . Management of Dyslipidemia by diet, exercise, and/or medication is associated with a major reduction in rates of heart attack and stroke. * High blood pressure – Hypertension or elevated blood pressure can increase a person's risk of developing<unk> . Similarly to<unk> , there is a known association between high blood pressure and heart attacks, strokes and abdominal aortic aneurysms. High blood pressure increases the risk of intermittent claudication, the most common symptom of<unk> , by 2.5- to 4-fold in men and women, respectively. * Other risk factors which are being studied include levels of various inflammatory mediators such as C-reactive protein, fibrinogen, homocysteine, and lipoprotein A. Individuals with increased levels of homocysteine in their blood have a 2-fold risk of<unk> . While there are genetics leading to risk factors for<unk> , including diabetes and high blood pressure; there have been no specific genes or gene mutations directly associated with the development of<unk> . High risk populations<unk> <unk> al<unk>  is more common in these populations:* * * * All people who have leg symptoms with exertion (suggestive of claudication) or ischemic rest pain * All people aged 65 years and over regardless of risk factor status * All people between 50 and 69 and who have a cardiovascular risk factor (particularly diabetes or smoking) * Age less than 50 years, with diabetes and one other atherosclerosis risk factor (smoking, dyslipidemia, hypertension, or hyperhomocysteinemia) * Individuals with an abnormal lower extremity pulse examination * Those with known atherosclerotic coronary, carotid, or renal<unk><unk>  * All people with a Framingham risk score of 10%–20% * All people who have previously experienced chest pain
Peripheral artery disease
Lumbar spinal stenosis
Chronic venous insufficiency
Varicose veins
Diabetic foot
Spinal stenosis
Diabetic foot ulcer
Raynaud syndrome