Role of Depression and Anxiety in Peripheral Artery Disease: Correlates, Outcomes, and Considerations for Treatment

Peripheral artery disease (PAD) affects millions worldwide and is associated with high mortality, major amputations, and detrimental effects on functional and health status. PAD management is multifactorial and encompasses addressing cardiovascular and metabolic risk factors, improving symptoms and vessel patency through exercise therapy or revascularization, and medications. PAD frequently develops under complex biopsychosocial circumstances, and those same mechanisms impact treatment and outcomes. In these contexts, depression and anxiety play a significant role and are known to be associated with a higher risk of developing PAD and worse disease and treatment outcomes. Incorporating depression and anxiety assessment and treatment can complement the traditional approach to cardiovascular disease management to improve outcomes, given that we know they influence the development and progression of PAD and its treatment. In this review, we evaluate various biological and behavioral mechanisms linking depression, anxiety, and PAD, as well as the role of depression and anxiety in treatment planning. We stress the importance of considering these disorders when managing PAD with both medical and surgical approaches and discuss future avenues for a holistic, team-based, and multidisciplinary approach to improve long-term outcomes in individuals with PAD.