Given the histopathological similarities between PAH and PAD, future mechanistic studies of PAD myofibrosis should determine whether chronic hypoxia directly induces TGF-β1 expression by SMC, and/or activates endothelial cells to increase production of pro-fibrotic factors that cause SMC to increase expression of TGF-β1. Here, TGFB1 is linked to peripheral arterial disease.