Table 2.

Health Disparities in PAD Risk Factors, Treatment, and Outcomes

Polyvascular disease	Black American patients have the highest rates of PAD with cerebrovascular disease. Hispanic and White American patients have the highest rates of PAD with coronary artery disease and PAD with both coronary artery disease and cerebrovascular disease.
Diabetic foot care	Native American, Black, and Hispanic patients have a higher risk of neuropathy, diabetic foot ulcers, and amputation. Native American, Black, Hispanic, rural, and low-income patients are at greater risk of being uninsured, an independent risk factor for amputation.
Medical management	Black American patients with PAD have lower rates of statin, aspirin, and angiotensin-converting enzyme inhibitor prescriptions. Hispanic American patients with PAD have low rates of statin, antiplatelet, and antihypertensive treatment.
Physical activity	Black American patients who live in more walkable communities have better control of their diabetes. Black American patients have an increased physical decline over time, largely explained by socioeconomic status and physical activity levels.
Lifestyle behaviors	Black and Hispanic American patients are less likely to follow a Mediterranean style or DASH dietary pattern. Black and Hispanic American patients have higher rates of obesity. American Indian and Alaska Native American patients have higher rates of smoking. Social determinants of health influence the presentation of patients.
Disease presentation	Black American patients with PAD have an increased risk of amputation than other groups with comparable PAD severity and comorbidities. Black American patients present with more advanced CLI/CLTI compared with White American patients. Black patients have lower ankle brachial indexes, increased arterial stiffness, and more small vessel disease. For inpatients, American Indian patients have the highest prevalence of presenting with CLI/CLTI. Black patients with CLI/CLTI are less likely to undergo limb salvage revascularization as opposed to major amputation.
Vascular interventions	Black, Hispanic, and Native American patients who live in certain regions of the United States are less likely to be offered invasive treatments and have higher rates of complications. For patients undergoing endovascular intervention, Black and Hispanic patients have an increased risk of mortality and poor outcomes. Black and Hispanic patients have higher rates of amputation, even after accounting for anatomic and risk factor burden. Black, Hispanic, and Native American patients are less likely to receive minor versus major amputations and walk with a prosthesis.

CLI indicates critical limb ischemia; CLTI, chronic limb-threatening ischemia; DASH, Dietary Approaches to Stop Hypertension; and PAD, peripheral artery disease.