Where your DNA places you among other people, and the studies behind it.
Not tailored to your result, and not medical advice
Quit Or Avoid Smoking: Tobacco smoke injures the artery lining and accelerates the atherosclerotic plaque that narrows the leg arteries, and the authors note the magnitude of the smoking association is larger for peripheral artery disease than for coronary artery disease. In a prospective cohort of 24,085 Swedish men followed about 9 years, with 655 new cases, current smokers had roughly four times the risk of never smokers (hazard ratio 4.01). Risk in former smokers fell the longer they had stopped: 2.61 within ten years of quitting and 1.38 at ten years or more. Swedish snus, a smokeless tobacco, showed no association in the same cohort, which the authors read as pointing to combustion products such as arsenic and carbon monoxide rather than nicotine itself. Scientific Reports (PMC)
Walk Regularly Even When Legs Ache: Structured walking is the best-studied non-clinical intervention for the exertional calf cramping that peripheral artery disease causes. A Cochrane review of 32 randomised trials in 1,835 people found exercise groups walked about 82 m further before pain started and about 120 m further before having to stop than controls, both rated high-quality evidence. The programs were generally at least twice a week, 30 minutes to an hour a session, run over six weeks to a year, though the trials varied widely in how they were specified and the review does not pin down how far into leg pain participants walked. Notably the review concluded that exercise did not improve the ankle-brachial index, so the gain appears to be in how efficiently the leg uses the blood it receives rather than in widening the narrowed artery itself. Cochrane Database of Systematic Reviews (PMC)
Stack The Basic Cardiovascular Habits: Peripheral artery disease is the same atherosclerotic process as coronary disease, expressed in the limb arteries, so the general cardiovascular risk profile applies. Among 7,122 PREDIMED participants followed a median 4.8 years, with 87 new cases, each one-point gain on the Life's Simple 7 score, which combines smoking, body mass index, physical activity, blood pressure, cholesterol, glucose metabolism and diet, was associated with 22% lower risk of developing the disease (hazard ratio 0.78). Participants scoring in the optimal band had about a quarter the risk of those scoring inadequate. Pooling four studies, the same analysis found a consistent 19% lower risk per point (hazard ratio 0.81), though the small number of events means the estimates are imprecise. Nutrients (PMC)
Take Leg And Foot Symptoms Seriously: The classic sign is pain, aching, heaviness or cramping in the legs, most often the calf, that comes on when walking or climbing stairs and eases with rest. In more advanced disease pain can be present at rest, and sores on the toes, feet or legs may heal slowly, may not heal at all, or may become infected; the foot can look pale or discoloured, and toenails and leg hair may stop growing. Silent disease is common, and NHLBI notes that about 1 in 5 people with peripheral artery disease report no symptoms at all while more than half have atypical ones. Any of these changes is worth getting looked at, and a conversation with a clinician is the right next step rather than something to work out alone. NHLBI
Eat A Mediterranean-Style Pattern: A systematic review of 40 studies of diet and peripheral artery disease found only one randomised trial addressing the question, a PREDIMED subgroup analysis, which suggested a Mediterranean pattern built on olive oil, nuts, vegetables, legumes and fish may protect against developing the disease. Nearly everything else was observational. The reviewers described a paucity of high-quality data and said the Mediterranean finding needs confirmation in larger dedicated studies. That is the honest state of the evidence here: the pattern is well supported for cardiovascular health broadly, but the specific case for preventing peripheral artery disease is thin. Canadian Journal of Cardiology (PubMed)
How much of this is genetic?
Genetics explains 25% of why people differ in this trait. The rest is environment, daily habits and chance.
Heritability estimate: Heritability estimates for peripheral artery disease range from ~20-30% in recent atherosclerosis-aligned analyses to ~48-58% in older twin studies; a conservative ~25% is used here (Klarin, Tsao & Damrauer, Circ Res 2021)
Background and further reading
Peripheral artery disease (PAD) is the buildup of atherosclerotic plaque in arteries that carry blood to the arms and legs, most commonly affecting the lower limbs. Narrowed arteries limit blood flow, and the classic symptom is intermittent claudication: cramping or aching in the calves, thighs, or buttocks that comes on with walking and eases with rest. Many people have no symptoms at all, so PAD is often underdiagnosed. It is common in older adults and affects more than 200 million people worldwide, with prevalence rising steeply with age. Because the same disease process affects arteries throughout the body, PAD is an important marker of overall cardiovascular health and is associated with higher rates of heart attack and stroke.
Genetic Basis: Estimates of PAD heritability vary with the method used: older twin studies suggested that around half of the variation in risk is inherited, while more recent analyses aligned with other atherosclerotic diseases place it closer to a quarter to a third. Either way, inherited variation contributes meaningfully but environmental and lifestyle factors dominate. PAD is highly polygenic and shares much of its genetic architecture with coronary artery disease and other atherosclerotic conditions. Well-established loci include the chromosome 9p21 region (near CDKN2A/CDKN2B), one of the strongest common risk signals for atherosclerosis, and the LPA gene, which sets lifelong levels of lipoprotein(a), a genetically determined atherogenic lipoprotein. Large biobank genome-wide studies have also implicated lipid-pathway genes such as LDLR and LPL, and variants influencing blood pressure, clotting, and inflammation add to risk. A polygenic score aggregates many such small-effect variants into a single estimate of inherited predisposition.
Environmental Factors: Lifestyle and medical factors have a very large influence on whether PAD develops. Cigarette smoking is the single strongest modifiable risk factor and dramatically accelerates arterial narrowing; diabetes is another major driver and is linked to more severe, distal disease. High blood pressure, elevated LDL cholesterol, chronic kidney disease, obesity, and physical inactivity all add to risk, while age and a family history of vascular disease are important non-modifiable contributors. Not smoking, managing blood sugar, blood pressure, and cholesterol, and staying physically active are the most effective ways to lower the chance of developing PAD or slow its progression.
The published research behind your score, and the variants it draws on.
2 published scores from 2 studies
The peripheral artery disease score combines 2 polygenic scores drawn from 2 published studies.
These traits are influenced by some of the same genes and variants as this one
Stroke: Interruption of blood flow to part of the brain by a clot or a bleed, injuring brain cells.
Content updated August 2026.
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