More than 202 million people worldwide are living with peripheral artery disease (PAD), a number that has increased 23.5 percent between 2000 and 2010, according to research published online Aug. 1 in The Lancet. The writer of an accompanying editorial told Cardiovascular Business that agencies should unite in an effort to prevent PAD.
In a review of 34 studies with a total of 112,027 participants from both high-income countries (HIC) and low-income or middle-income countries (LMIC), the authors, led by F. Gerald R. Fowkes, PhD, of the University of Edinburgh in Edinburgh, U.K., found that while PAD is on the rise around the world, the 10-year increase has been greatest in LMIC, at 28.7 percent, compared with 13.1 percent in HIC. About 70 percent of people with PAD are living in LMIC.
The studies included in the analysis were all published since 1997 and defined PAD as an ankle brachial index (ABI) less than or equal to 0.9.
“The most striking differences in prevalence were higher rates in HIC than in LMIC for men, and, the higher prevalence of women with the disease than men in LMIC,” the authors wrote. This trend was especially noticeable among younger people.
One of the main reasons for the increased prevalence is because people are living longer.
“[L]onger life expectancy in LMIC is responsible for higher-than-ever numbers of people reaching the age of 55 and over, when the risk of developing peripheral artery disease is accelerated,” the authors explained.
The analysis also revealed that the risk factors of age, smoking, diabetes and cardiovascular history played a significantly greater role in HIC, which could be explained by the fact that the studies from HIC encompassed a broader age range. It is also possible that people in LMIC were not exposed to risk factors for as long a period of time.
Nonetheless, the authors concluded, risk factors still pose a significant problem and are likely to contribute to a continued increase in global PAD.
In an accompanying editorial, Alan T. Hirsch, MD, and Sue Duval, PhD, of the University of Minnesota Medical School in Minneapolis, argued that the true burden of PAD is likely much higher than the analysis revealed, since ABI is not a fully diagnostic test, although it is accurate and practical. Other methods, however, are neither easy nor cost-effective.
“ABI detects PAD when there is at least one high-grade stenosis,” Hirsch told Cardiovascular Business. “But PAD is also defined to be present and is dangerous when defined by the presence of any plaque that exists in leg arteries.”
He stressed that the greater number of people living with the disease is not related to better awareness and detection.
“As with any noncommunicable chronic disease, the increase in prevalence would be best explained due to a greater biological exposure to causal risk factors,” Hirsch explained. “The studies used by Fowkes et al did not require patients to be aware of PAD to assure its detection.”
There could be relatively easy solutions to what Hirsch and Duval called a “global pandemic.” Addressing the growing problem requires a far-reaching solution that would lower exposure to each risk factor, such as smoking or diabetes, and would improve access to preventive healthcare.
Healthcare consumers need to advocate for themselves and insist on access to simple ABI measurements. In addition, the various healthcare sectors need to devote the same attention to PAD as they do to heart disease and other medical conditions.
“Very few countries have invested deeply in atherosclerosis prevention and none in PAD prevention,” Hirsch said. “We would like health organizations, government, business and public health agencies to align their focus to prevent PAD and improve global vascular health.”