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Aging, Menopause & PAD Risk

Why does age affect my risk of peripheral artery disease?

Like other forms of heart disease, a woman’s risk of peripheral artery disease increases as she gets older.1 There are several reasons for this:

First, atherosclerosis, the buildup of fatty plaque in the arteries, is a lifelong process. Atherosclerosis is the most common cause of artery disease, including PAD. Fatty plaque gradually builds up over time, so the older you are, the greater the chances that an artery will have become narrowed or blocked enough to cause blood flow problems. As you age, other conditions that put you at risk for PAD also become more common and more severe, including high blood pressure, high cholesterol, and excess weight.

For women, the hormonal changes of menopause are an added dimension to the link between aging and PAD. During menopause (usually between age 45 and 55) a woman’s body begins producing less of the female hormones estrogen and progesterone. These hormones are thought to have artery-protecting effects, so as their levels drop a woman’s risk of heart and blood vessel disease increases.

See also: Aging & Vein Disease Risk

How do age and menopause affect my risk of PAD?

Although PAD can occur at any age, it becomes much more common as you get older. This is true of all types of peripheral artery disease, including PAD in the legs, carotid artery disease, kidney artery disease, and aortic disease.

A woman is automatically at high risk for PAD if she is 70 or older. If she has other risk factors, she may be considered high risk at a younger age. Women 50 or older who have ever smoked or who have diabetes, and women younger than 50 who have additional PAD risk factors are considered high risk. Nearly 1 in 3 women older than 70, or 50 or older who smoke or have diabetes, have PAD.2


The risk of PAD in arteries other than your legs also increases as you age. Only 1 in 25 women younger than 70 has carotid artery disease, compared with 1 in 10 older than 80.3 Aortic aneurysms (bulging out of the large artery that runs from the heart through the chest and abdomen) are 50 times more common in women 75 or older than in women under 55 years of age.4

Should I consider hormone replacement therapy to reduce my PAD risk?

No. Studies have shown that replacement estrogen does not have the same benefits as your body’s natural estrogen in protecting your heart and blood vessels, and hormone replacement therapy (HRT) slightly increases a woman’s risk of developing heart disease and stroke.26,27 There is no evidence that HRT can reduce your risk of developing PAD, and it actually increases a woman’s risk of developing blood clots in the veins (deep vein thrombosis or pulmonary embolism) by 2 to 4 times.5

To learn more about the overall risks and benefits of hormone therapy, as well as who may want to consider taking it to treat menopausal symptoms, see Hormone Therapy & Heart Disease.

What can I do to reduce my risk of PAD as I get older?

However much we might like to, we cannot change our age or its effect on our risk of heart and blood vessel disease. However, you can change many other characteristics and conditions that put you at risk for PAD. The older you get, the more important it becomes to get your other PAD risk factors under control. Older women with PAD are at especially high risk for potentially deadly complications of artery disease such as heart attack and stroke.6

The first step in taking control of your PAD risk is to work with your doctor to find out what your risk factors are and develop a treatment plan to get your numbers where they need to be. Lifestyle changes such as a heart-healthy diet and exercise are a major part of risk factor control. Talk to your doctor about what level of activity is safe for you and aim for at least 30 minutes of exercise each day. It is never too late to start making heart-healthy changes to reduce your risk, and many of these changes can also help prevent heart disease and stroke.

You should also inform yourself about the signs and symptoms of PAD. Many older women with PAD may not notice the symptoms because they are not active enough to experience them, or they may not mention their symptoms to their doctor.7 Remember, pain in your legs is not necessarily a normal sign of aging. Proven treatments are available to relieve your symptoms and prevent complications, so be sure to discuss any symptoms you experience with your doctor. See Preventing PAD: The Basics for steps you can take to lower your risk and ensure you lead an active, healthy life well into old age.

If you have already been diagnosed with PAD, getting proper treatment can reduce your symptoms, improve your quality of life, and make you more independent and better able to engage in leisure and social activities.8,9 See our PAD Treatment section for more.

See also:

Aging and Heart Disease
Aging & Stroke Risk
Aging & Heart Failure



  1. Criqui MH, Fronek A, Barrett-Connor E, Klauber MR, Gabriel S, Goodman D. The prevalence of peripheral arterial disease in a defined population. Circulation. Mar 1985;71(3):510-515.
  2. Hirsch AT, Criqui MH, Treat-Jacobson D, et al. Peripheral Arterial Disease Detection, Awareness, and Treatment in Primary Care. JAMA. September 19, 2001 2001;286(11):1317-1324.
  3. O'Leary DH, Polak JF, Kronmal RA, et al. Distribution and correlates of sonographically detected carotid artery disease in the Cardiovascular Health Study. The CHS Collaborative Research Group. Stroke. Dec 1992;23(12):1752-1760.
  4. Hirsch AT, Haskal ZJ, Hertzer NR, et al. ACC/AHA 2005 Practice Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic): A Collaborative Report from the American Association for Vascular Surgery/Society for Vascular Surgery,* Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): Endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation. Circulation. March 21, 2006 2006;113(11):e463-465.
  5. Rossouw JE, Anderson GL, Prentice RL, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women's Health Initiative randomized controlled trial. JAMA. Jul 17 2002;288(3):321-333.
  6. Aronow WS. Management of Peripheral Arterial Disease of the Lower Extremities in Elderly Patients. J Gerontol A Biol Sci Med Sci. February 1, 2004 2004;59(2):M172-177.
  7. McDermott MM, Greenland P, Liu K, et al. Leg symptoms in peripheral arterial disease: associated clinical characteristics and functional impairment. JAMA. Oct 3 2001;286(13):1599-1606.
  8. Kuo H-K, Yu Y-H. The Relation of Peripheral Arterial Disease to Leg Force, Gait Speed, and Functional Dependence Among Older Adults. J Gerontol A Biol Sci Med Sci. April 1, 2008 2008;63(4):384-390.
  9. Falconer TM, Eikelboom JW, Hankey GJ, Norman PE. Management of peripheral arterial disease in the elderly: focus on cilostazol. Clin Interv Aging. 2008;3:17-23

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