Global, regional, and national burden of lower extremity peripheral arterial disease attributable to high BMI: temporal trends from 1990 to 2021 and forecasts to 2035

Abstract Background Lower extremity peripheral arterial disease (PAD) is a significant vascular complication that is increasingly correlated with a high body mass index (BMI). Understanding its spatio-temporal trends is vital for efficacious prevention and management. This study aimed to estimate the global, regional, and national burden of PAD attributable to high BMI from 1990 to 2021 and forecast its trajectory to 2035. Methods Data on disability-adjusted life years (DALYs) and mortality were extracted from the Global Burden of Disease (GBD) Study 2021. Trends in age-standardized rates (ASRs) were assessed by employing the estimated annual percentage change (EAPC). Socio-demographic index (SDI) levels, sex, and age groups were analyzed to assess disparities in health outcomes. An autoregressive integrated moving average (ARIMA) model was applied to forecast the global burden to 2035. Results Globally, the absolute number of DALYs attributable to high BMI-related PAD was 300.91×10³ in 2021, while the ASR was 3.57 per 100,000, with a − 3.31% change since 1990 (EAPC: − 0.46%). Mortality declined by 12.77% (ASR: 0.17 per 100,000; EAPC: − 0.79%). High SDI regions had the highest burden but remained stable, whereas low- and middle-SDI regions showed substantial increases in DALYs (up to 146.17%) and mortality (up to 193.19%). Marked regional heterogeneity was observed, with the largest proportional increases in Eastern Sub-Saharan Africa, Western Sub-Saharan Africa, and South Asia. Males exhibited a slightly greater reduction in DALYs, while mortality trends were similar between sexes. The burden was minimal below 40 years and increased progressively with age, reaching its highest levels among individuals aged 85 years and older. ARIMA forecasts suggest that DALYs will rise slightly to 3.70 per 100,000 by 2035, while mortality will decline modestly to 0.15 per 100,000. Conclusion Despite modest global reductions in mortality, the disability burden of high BMI-related PAD remains substantial and is shifting towards low- and middle-income regions. Targeted strategies focusing on overweight and obesity prevention, early vascular screening, and improved access to care are vital in mitigating the future burden.