The global burden of peripheral artery disease attributable to high fasting plasma glucose: a comprehensive analysis from 1990 to 2021 and projections to 2036

Background and purpose: The global burden of peripheral artery disease (PAD) attributable to high fasting plasma glucose (HFG) has not been comprehensively characterized. This study aimed to quantify the global deaths and disability-adjusted life years (DALYs) of PAD attributable to HFG and to project their trends through 2036. Methods: Data on PAD-related deaths and DALYs were obtained from the Global Burden of Disease 2021 Study. Temporal trends were evaluated using estimated annual percentage change (EAPC) and age-period-cohort (APC) models, while future projections were derived from a Bayesian (Bayesian APC) model. Cross-national inequalities were assessed in relation to the sociodemographic index (SDI). All analyses were performed in 2024. Results: Globally, from 1990 to 2021, the overall age-standardized mortality rate (ASMRs) and DALY rate (age-standardized disability rates [ASDRs]) for all-cause PAD decreased by 35.9% and 30.1%, respectively. However, the ASMRs and ASDRs for PAD specifically attributable to HFG increased by 15.3% (95% uncertainty interval [95% UI]: 6.6–24.7) and 20.0% (95% UI: 11.9–29.1). This rise was more pronounced in women, with increases of 15.9% (95% UI: 5.0–26.9) in ASMRs and 21.9% (95% UI: 13.2–31.5) in ASDRs, compared to 12.5% (95% UI: 2.0–24.4) and 17.1% (95% UI: 7.3–27.2) in men, respectively. In 2021, HFG was responsible for 67,744 (95% UI: 59,937–74,257) PAD-related deaths and 1,558,243 (95% UI: 1,266,999–2,045,869) DALYs. Absolute inequality (slope index of inequality) in PAD burden widened over time, with the burden disproportionately concentrated in low- and middle-SDI countries. Projections to 2036 indicate a continued increase in the HFG-attributable PAD burden among women, while a slight decline is projected for men. Conclusions: The global burden of PAD is increasingly driven by HFG, with a disproportionate and growing impact on women and populations in low- and middle-SDI countries. Our findings underscore an urgent need for targeted public health policies that address gender and socioeconomic disparities. Implementing evidence-based interventions focused on glycemic control is critical to mitigating the rising global burden of HFG-attributable PAD.