The epidemiology of atherosclerotic peripheral arterial disease (PAD) has rarely been studied in Asia. A prospective vascular registry consisting of 510 Chinese patients with PAD from a teaching hospital in Hong Kong disclosed a male/female ratio of 1.6:1.0 with a mean age of 72 years. The predominant pattern was femoropopliteal occlusive disease (49%). Half of all patients had tissue loss on presentation, more so in women (67%) than men (38%). Demographic and biochemical risk factors examined showed many similarities with the West, included smoking (59%), hypertension (55%), diabetes mellitus (42%), hypercholesterolemia (55%), elevated low density lipoprotein (LDL) (60%), triglycerides (31%), hyperfibrinogenemia (62%), and hyperglycemia (49%). Chinese female patients with PAD were older and had a high prevalence of diabetes mellitus (54%). Smoking is less a problem in women (28%). They suffered predominantly from femoropopliteal and distal vessel disease, and two-thirds presented with tissue loss. Female patients also have significantly higher levels of fasting glucose, cholesterol, triglyceride, LDL, and very low density lipoprotein (VLDL). Male patients were mostly smokers (80%) with a higher proportion of aortoiliac disease. Critical ischemia in the form of tissue loss was associated with female sex (p < 0.001), age (p < 0.001), nonsmoking (p < 0.001), diabetes (p < 0.005), a low hemoglobin/hematocrit (p < 0.001), a high white blood cell count (p < 0.001), and high levels of fibrinogen (p < 0.01) and cholesterol (p < 0.05). An increasing incidence of PAD was noted in Hong Kong. Most of the patients present late with advanced ischemia. It is possible that this disease pattern represents only a fraction of the true incidence of PAD in the territory.