Abstract Body (Do not enter title and authors here): Introduction: Lower Extremity Peripheral Arterial Disease (PAD) ranks as the leading cause of incidence among all cardiovascular diseases (CVD) in the United States. Due to a significant lack of data on the overall burden of PAD, this pioneering study investigates the trends of PAD over the past three decades in the US, including the initial two years of the COVID-19 pandemic.

Method: We estimated prevalence, incidence, deaths, and disability-adjusted life years (DALYs) due to PAD by age, sex, year and location across the US from 1990-2021 using the global burden of disease 2021 methodology. Results were presented in absolute counts and age-standardized rate (per 100,000 person-years)

Results: From 1990 to 2021, the overall prevalence of PAD in the US rose from 8.6 million (95% uncertainty interval: 7.4-10 million) to 14.9 million (13.4-16.6 million). The total percentage change (TPC) in deaths increased by 93% (82%-102%), and DALYs by 87% (79%-96%). Pennsylvania recorded the highest increase in age-standardized incidence rate (ASIR) at 3%, followed by Delaware at 2%. Kansas saw the highest death rate (ASMR) increase at 20%, with Kentucky close behind at 19%. The 65-69 age group had the highest incidence count at 265,188, while the 85-89 age group saw the most deaths at 1,827, and the 70-74 age group recorded the most DALYs at 36,772 in 2021. Males experienced a higher increase in TPC across incidence, deaths, and DALYs compared to females, with figures at 85% vs 56%, 104% vs 85%, and 99% vs 76%, respectively.

Conclusion: While deaths due to Peripheral Arterial Disease (PAD) constituted only 1.22% of all cardiovascular-related fatalities in the US in 2021, the growing burden of the disease highlights a critical area for public health focus. Although mortality rates remain relatively low, the high incidence compared to other cardiovascular diseases suggests the need for targeted prevention and early intervention strategies. Strengthening awareness, improving diagnostics, and enhancing treatment accessibility can help mitigate the rising impact of PAD and improve cardiovascular health outcomes nationwide.