Peripheral Artery Disease (P.A.D.)

Causes, Risk Factors, and Prevention

What Causes P.A.D.?

The most common cause of P.A.D. is atherosclerosis, a buildup of plaque in the arteries. The exact cause of atherosclerosis isn't known. The disease may start if certain factors damage the inner layers of the arteries. These factors include

  • smoking
  • high amounts of certain fats and cholesterol in the blood
  • high blood pressure
  • high amounts of sugar in the blood due to insulin resistance or diabetes.

Risk Factors

P.A.D. affects millions of people in the United States. The disease is more common in African Americans than any other racial or ethnic group.

The major risk factors for P.A.D. are

  • smoking
  • older age
  • having certain diseases or conditions.

(Watch the videos on this page to learn more about P.A.D. risk factors and prevention. To enlarge a video, click the brackets in the lower right-hand corner of the video screen. To reduce a video, press the Escape (Esc) button on your keyboard.)


Smoking is the main risk factor for P.A.D. Your risk of P.A.D. increases four times if you smoke or have a history of smoking. On average, people who smoke and develop P.A.D. have symptoms 10 years earlier than people who don't smoke and develop P.A.D.

Quitting smoking slows the progress of P.A.D. People who smoke and people who have diabetes are at highest risk for P.A.D. complications such as gangrene (tissue death) in the leg from decreased blood flow.

Older Age

Older age also is a risk factor for P.A.D. Plaque builds up in your arteries as you age. Older age combined with other factors, such as smoking or diabetes, also puts you at higher risk for P.A.D.

Diseases That Put You at Risk

Many diseases and conditions can raise your risk of P.A.D., including

  • diabetes.
  • high blood pressure
  • high blood cholesterol
  • coronary heart disease (CHD)
  • stroke
  • metabolic syndrome (a group of risk factors that raise your risk of coronary heart disease and other health problems, such as P.A.D., stroke, and diabetes).

Reducing Your Risk for P.A.D.

Taking action to control your risk factors can help prevent or delay P.A.D. and its complications. Know your family history of health problems related to P.A.D. If you or someone in your family has the disease, be sure to tell your doctor.

Controlling risk factors for P.A.D. includes doing the following.

  • If you smoke, quit.. Talk with your doctor about programs and products that can help you quit smoking. You can also call a smoking quitline. The National Cancer Institute’s Smoking Quitline at (877) 44U-QUIT or (877) 448-7848 is available between 8:00 a.m. and 8:00 p.m. Eastern Time. You can also call (800) QUIT-NOW or (800) 784-8669 to be connected with free resources about quitting and counseling information in your state.
  • Get regular exercise and physical activity. For physical activities geared to older adults, see “Exercises to Try.”
  • Be screened for P.A.D. A simple office test, called an ankle-brachial index or ABI, can help determine whether you have P.A.D.
  • Lose weight if you’re overweight or obese. Work with your doctor to create a reasonable weight-loss plan.

These lifestyle changes can reduce your risk for P.A.D. They can also help prevent and control conditions that can be associated with P.A.D., such as coronary heart disease, diabetes, high blood pressure, high cholesterol, and stroke.