AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Thirty Years of Lower-Extremity Peripheral Arterial Disease in Europe: Spatiotemporal Burden, Socioeconomic Disparities, Etiologic Shifts, and Projections to 2035
By Jaiswal V, Ilyas N, Jaiswal A et al.
Background: Lower Extremity Peripheral Arterial Disease (LEPAD) contributes substantially to cardiovascular morbidity and mortality across Europe; current continental-scale spatiotemporal trends, socioeconomic gradients, and changing attributable risks are incompletely defined. Hypothesis: To assess long-term LEPAD trends (1990-2023) across 44 European countries, sex- and socioeconomic disparities, shifts in attributable risks, and forecast burden to 2035. Methods: Extracted age-standardized DALY rates from GBD 2023 for Central, Eastern, Western Europe. Estimated Annual Percentage Change (EAPC) used Newey-West SEs with Benjamini-Hochberg correction. Convergence tested via beta- and sigma-frameworks. Spatiotemporal GAM (Gamma) modeled SDI-burden interactions by sex. Spatial clustering by Local Moran’s I. Dominant drivers from GBD PAFs. Absolute DALYs projected to 2035 with ARIMA. Results: Latvia exhibited the highest burden acceleration (EAPC: +1.14%; 95% CI: 0.73-1.55) while Norway recorded the steepest decline (EAPC: –3.51%; 95% CI: –3.97 to –3.04), representing a nearly 5 percentage-point divergence across Europe. Beta-convergence (β= –0.04, p<0.001, R ² =0.42) indicated that countries with historically lower burden experienced relatively greater increases over time. GAM modeling demonstrated an inverse association between SDI and LEPAD burden, with males in low-SDI environments carrying 1,027,857 more absolute DALYs than their high-SDI counterparts (Rate Ratio: 1.51), a disparity markedly blunted in females (1.05). An age-dependent reversal in sex-specific burden was observed after age 80 years, where female DALY rates surpassed those of males, underscoring differential aging vulnerability. Metabolic risk factors accounted for a growing proportion of attributable LEPAD burden: by 2023, kidney dysfunction (PAF: 27.8%; 95% UI: 16.9-38.5%) and high BMI (PAF: 25.8%) were among the leading attributable risk factors alongside smoking (PAF: 25.5%), while smoking's PAF in males (43.4%) dwarfed that in females (12.1%). The YLD-to-YLL ratio remained below 1.0 throughout the study period, suggesting that mortality contributed more substantially than disability to overall disease burden. ARIMA forecasting projects a sustained escalation of absolute regional burden, with total DALYs rising from 650,423 in 2024 to 687,976 (95% PI: 615,390-760,562) by 2035, concentrated disproportionately within already-strained high-burden nations. Conclusions: LEPAD burden remains significant and uneven across Europe, concentrated in lower-SDI countries; cardiometabolic risks - notably kidney dysfunctionm, obesity and smoking - are increasingly prominent. Coordinated comprehensive prevention targeting traditional and emerging risks and ongoing surveillance are warranted.