TwPAD registry: A prospective, multicenter registry of chronic peripheral arterial disease involving lower limbs in Taiwan

Background: Peripheral arterial disease (PAD) is a consequence of systemic atherosclerosis, resulting in arterial narrowing and diminished blood flow, leading to complications like claudication, rest pain, ulcers, gangrene, and functional limitations. Despite its impact on cardiovascular mortality, physical function, and quality of life, PAD has received less attention than other atherosclerotic disorders. This study addresses the paucity of comprehensive clinical data on PAD in Taiwan, aiming to analyze its incidence, risk factors, pharmacological and interventional treatments, and outcomes. Methods: This prospective, multicenter, observational registry includes PAD patients from 10 medical centers or teaching hospitals across Taiwan. Data collected encompass demographic characteristics, medical history, laboratory results, and treatment history. Patients are followed up annually to monitor all-cause mortality, major clinical events (cardiovascular death, nonfatal myocardial infarction, nonfatal stroke), and total cardiovascular events (including hard events, unplanned revascularizations, hospitalizations for endovascular therapy, stroke, transient ischemic attacks, and heart failure). Results: From September 2020 to December 2022, 1005 patients were enrolled. The mean age of the cohort was 70.3 years, with men constituting the majority (59.3%). The prevalence rates of key medical conditions were 68.2% for diabetes, 76.3% for hypertension, 72.6% for hypercholesterolemia, 40.6% for smoking, and 26.2% for end-stage renal disease. Central Taiwan patients were younger and had a higher body mass index (BMI) and prevalence of obesity, but lower rates of comorbidities such as hypertension, diabetes, and smoking history. In contrast, eastern Taiwan patients who were older had a lower BMI and prevalence of obesity, but exhibited higher levels of comorbidity. Conclusion: The TwPAD registry provides comprehensive insights into patient characteristics, treatments, and outcomes. Regional variations in age, BMI, and comorbidity levels were noted between central and eastern Taiwan. Importantly, the registry identified gaps in adherence to guideline-directed medical therapy, particularly in statin use. Continued data collection will support improvements in PAD management nationwide.