Putting Peripheral Artery Disease Into Perspective
It used to be said that peripheral artery disease (PAD) doesn’t kill you; coronary artery disease (CAD) does. But recent studies suggest that life underwriters need to look more closely at PAD.
PAD comes in different forms, presenting very different risks - but it causes significant morbidity and mortality. Atherosclerotic PAD especially is a common disorder of older people with a mean age over 65; around 5% of people in their 60s and up to 20% of individuals over age 80 are affected.
“Peripheral” can refer to different arteries, but leg and arm arteries are always included and it can also take in carotids and renal arteries. Risk factors for PAD are similar to risk factors for coronary artery disease (CAD) and include smoking, diabetes, family history, hypertension, and lipids. A VA study of men with PAD reported that more than 90% were current or prior smokers. Diabetes is also disproportionately represented in individuals with PAD.
Most people with PAD do not report symptoms leading to a diagnosis and so screening tests are gaining popularity. The most commonly used screening test is the Ankle-Brachial Index (ABI), also known as Ankle-Arm Index (AAI).
Depending on the diagnostic methods used, CAD has been shown to be present in virtually all PAD patients. Not everyone with PAD has obstructive CAD but increased mortality from CAD is not related solely to obstruction. Vascular and cardiac causes of mortality are still very high in the PAD population without obstructive coronary disease.
Authors making general comments about PAD cite mortality rates two to five times the expected rate.
It seems that PAD is actually an excellent marker for CAD. Perhaps it is time for life underwriters to rewrite the old saying from, “PAD doesn’t kill you; CAD does” to "PAD doesn’t kill you; systemic vascular disease does - and unfortunately everyone with PAD has systemic vascular disease."
Read my full publication for a detailed examination of the insurance issues around peripheral artery disease.