Peripheral vascular disease (PVD) is an atherosclerotic disease of the distal arterial system typically affecting the lower limbs. This syndrome encompasses a wide range of patients from those with asymptomatic arterial narrowing to those with intermittent claudication, and at the extreme end of the spectrum, patients with critical limb ischaemia and gangrene. The common pathophysiological mechanisms underlying the development of PVD and other atherosclerotic diseases are reflected in the fact that patients often have concomitant coronary artery and cerebrovascular disease. Over the last 20 years, a number of studies have established the importance of birth weight as a determinant of both coronary heart disease and cerebrovascular mortality.^1,2 By contrast there has been very little work investigating the possible influence of the prenatal environment on the later development of peripheral vascular disease. In this review, we will summarise the epidemiological work conducted on peripheral vascular disease. In addition, we will appraise the evidence that birth weight is associated with the development of this disease. Finally, we will analyse the possible mechanisms underlying such an association using the information gained from both human and animal studies.

EPIDEMIOLOGY OF PERIPHERAL VASCULAR DISEASE

Symptomatic PVD is a relatively common condition with a prevalence of around 7% in adults over the age of 55 years.³ This disease has a relatively benign course—only one quarter of patients with intermittent claudication experience deterioration of symptoms and the annual risk of amputation for a patient with PVD has been estimated at only 1%.³ Unfortunately, there have to date been relatively few epidemiological studies examining risk factors for the development of PVD. Part of the reason for this may lie in the lower public profile of PVD, as compared with coronary heart disease. In addition, unlike coronary artery and cerebrovascular disease, PVD is not a fatal condition in itself, and …