AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
High Fasting Plasma Glucose and the Rising Midlife Burden of Lower-Extremity Peripheral Artery Disease, 1990-2023
By Gohil N, Sachdeva P, Vengala T et al.
Introduction/Background: High fasting plasma glucose (HFPG) is a modifiable cardiometabolic risk factor for atherosclerotic vascular disease. While lower-extremity peripheral artery disease (PAD) is commonly considered a disease of older adults, worsening glycemic risk may be shifting PAD-related morbidity into midlife. We evaluated global trends in HFPG-attributable lower-extremity PAD burden among adults aged 40-64 years from 1990 to 2023. Research Question/Hypothesis: We examined whether the HFPG-related lower-extremity PAD burden increased among midlife adults from 1990 to 2023, and whether the rise was more pronounced among females and in high-middle SDI regions than in high SDI regions. Methods/Approach: We analyzed Global Burden of Disease 2023 estimates for lower-extremity PAD attributable to HFPG among adults aged 40-64 years from 1990 to 2023. Deaths and disability-adjusted life years (DALYs) were extracted as counts and rates per 100,000 population. Trends were assessed globally and stratified by sex, 5-year age group, and Sociodemographic Index (SDI) region, with comparison of high-middle and high SDI regions. Percent change from 1990 to 2023 was calculated for counts and rates, and estimated annual percentage change (EAPC) was derived using log-linear regression of annual rates. Results/Data: The number of DALYs for HFPG-attributable lower-extremity PAD among individuals aged 40-64 years globally increased by 155.6% from 23,680 in 1990 to 60,524 in 2023. The DALY rate likewise increased from 2.20 to 2.75 per 100,000 population, a 25.4% increase, with an EAPC of 0.69% per year. Deaths climbed from 579 to 1,404, and the death rate increased from 0.054 to 0.064 per 100,000 population. Relative increases were greater in females than males for the DALY count (209.1% vs 130.9%) and the DALY rate (49.9% vs 14.5%). In 2023, the greatest absolute burden was among individuals aged 60-64 years, with 34,817 DALYs and 821 deaths. High-middle SDI regions experienced faster growth than high SDI regions in DALY counts (271.2% vs 91.3%), DALY rates (59.6% vs 14.6%), and deaths (274.7% vs 82.9%). Conclusion: The increasing midlife burden of HFPG-attributable lower-extremity PAD suggests that metabolic vascular disease is emerging well before older age, with important implications for prevention. These findings support midlife as a critical window for identifying glycemic risk, intensifying cardiometabolic risk reduction, and integrating lifestyle-, glucose-, and weight-directed strategies to reduce downstream PAD-related disability.