Modifiable
Applied
Type
ReinforcementConfidence
90%
Created
Mar 18, 2026
Evidence
1 source
Rationale
The section was updated to incorporate the 2025 ACC Scientific Statement on PAD in patients with diabetes, which emphasizes the high risk of CLTI in this population. Additionally, all medical abbreviations (PAD, DM, CLTI, CKD, LDL, HDL) were expanded upon their first use in the section to comply with the specified editorial standards.
Evidence
Content Changes
- Smoking: most important risk factor; increases peripheral artery disease (PAD) risk 2–4 fold. Smoking cessation improves survival and limb salvage (Willigendael 2004)📄.
- Diabetes mellitus (DM): accelerates medial calcification, distal disease, and restenosis risk. It is a major risk factor for chronic limb-threatening ischemia (CLTI), requiring comprehensive risk factor modification and multidisciplinary care (Das 2025).
- Hypertension: contributes to endothelial dysfunction, shear stress, and plaque rupture.
- Dyslipidemia: elevated low-density lipoprotein (LDL) and reduced high-density lipoprotein (HDL) promote plaque formation.
- Chronic kidney disease (CKD): accelerates atherosclerosis and is associated with a higher risk of vascular calcification.
Before
- Smoking: most important risk factor; increases PAD risk 2–4 fold. Smoking cessation improves survival and limb salvage (Willigendael 2004)📄.
- Diabetes mellitus: accelerates medial calcification, distal disease, and restenosis risk. Major risk factor for CLTI.
- Hypertension: contributes to endothelial dysfunction, shear stress, plaque rupture.
- Dyslipidemia: elevated LDL and reduced HDL promote plaque formation.
- Chronic kidney disease (CKD): accelerates atherosclerosis, higher risk of calcification.
After
- Smoking: most important risk factor; increases peripheral artery disease (PAD) risk 2–4 fold. Smoking cessation improves survival and limb salvage (Willigendael 2004)📄.
- Diabetes mellitus (DM): accelerates medial calcification, distal disease, and restenosis risk. It is a major risk factor for chronic limb-threatening ischemia (CLTI), requiring comprehensive risk factor modification and multidisciplinary care (Das 2025).
- Hypertension: contributes to endothelial dysfunction, shear stress, and plaque rupture.
- Dyslipidemia: elevated low-density lipoprotein (LDL) and reduced high-density lipoprotein (HDL) promote plaque formation.
- Chronic kidney disease (CKD): accelerates atherosclerosis and is associated with a higher risk of vascular calcification.