May 2026

GERIATRICS

PERIPHERAL ARTERY DISEASE IN THE LEGS: A CARDIOVASCULAR AND FUNCTIONAL HEALTH PRIORITY IN OLDER ADULTS

Peripheral artery disease (PAD) affects approximately 236 million people globally and increases markedly with age. Defined by an ankle–brachial index (ABI) of less than 0.90, PAD is a manifestation of systemic atherosclerosis and a major contributor to functional decline, disability and cardiovascular morbidity risk in older populations.

A recent clinical review by Mary M. McDermott, MD, of Northwestern Medicine, and published in The New England Journal of Medicine, provides an evidence‑based framework for PAD evaluation and management in older adults. Drawing on decades of research focused on vascular disease and functional outcomes, the analysis emphasizes PAD as a condition with profound implications on mobility and independence.

The study showed that mobility declines significantly with increasing PAD severity. Among older adults, inability to complete a six‑minute walk test without rest rises from 3.3% in those without PAD to 18.1% with mild disease and 52.0% with severe PAD, underscoring the substantial impact on daily function and quality of life.

Management centers on aggressive cardiovascular risk reduction, including intensive lipid‑lowering therapy, antithrombotic treatment, blood pressure control to <130/80 mm Hg, and the use of cardioprotective therapies such as semaglutide and SGLT2 inhibitors in patients with diabetes.

For symptom management, supervised and structured home‑based walking exercise are first‑line therapies shown to improve walking ability. Lower‑extremity revascularization should be reserved for patients with persistent, lifestyle‑limiting symptoms despite optimal medical therapy and exercise.
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This work reinforces that PAD should be managed as a high‑risk systemic disease rather than an isolated peripheral condition.  Early identification, aggressive cardiovascular risk reduction, and structured functional interventions are essential to improving outcomes and maintaining mobility and independence in older adults.
Read the full analysis 

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