1. Prevalence of peripheral artery disease (PAD) has increased by 23.5% between 2000 and 2010, and now affects over 202 million people globally.
2. More than two-thirds of people living with PAD live in low- and middle-income countries.
3. Change in PAD prevalence is greatest in those older than 80 years of age, with a rise of more than 35% in one decade.
Evidence Rating Level: 1 (Excellent)
Study Rundown: Lower limb peripheral artery disease (PAD) is the third leading cause of atherosclerotic vascular morbidity after coronary heart disease and stroke. However, to date there has not been a significant study to determine the worldwide and regional prevalence of PAD.
The results of this study reveal a rapid rise in the prevalence of PAD from 164 million in 2000 to 202 million in 2010 for a net increase of 23.5%. This rise was seen in both high and low-middle income countries with no significant difference in age-specific prevalence. However, in high-income countries, those diagnosed with PAD were equally likely to be men and while those diagnosed in low-middle income countries were more likely to be women. Finally, of 15 risk factors analyzed, there were several associated with significantly increased odds of PAD development: current or former smoking status, history of another cardiovascular disease (e.g. CHD and stroke), diabetes, hypertension, and hypercholesterolemia.
The study is the first large scale report that has sought to determine the global prevalence of PAD and determine significant risk factors for development of PAD based on regional factors. Limitations at this time include the quality of data from some regions and that this study has a limited number of countries included. While this is the largest study to date studying global PAD prevalence, its findings based on data from 19 countries, which may or may not be truly representative for the world (e.g. this study included data from only 1 South American country).
Further, this study provides no follow-up data regarding outcomes of PAD in these differing global settings. Thus, it remains difficult to determine what impact this rise in prevalence has on global public health.
Relevant Reading: The impact of peripheral arterial disease on health-related quality of life in the Peripheral Arterial Disease Awareness, Risk, and Treatment: New Resources for Survival (PARTNERS) Program
Lead author Professor Gerry Fowkes speaks to 2 Minute Medicine: University of Edinburgh, United Kingdom
“PAD has become a global problem in the 21st century and can no longer be regarded as a disease that affects mostly HIC. The dramatic growth in PAD is already a major public health challenge due to loss of mobility, diminished quality of life, and the significantly increased risk of heart attack and stroke. As the world’s population ages, PAD will become substantially more common, and there is an urgent need to assess treatment and prevention strategies in both HIC and LMICs.”
In-Depth [meta-analysis]: This study includes 34 epidemiological studies of 112,027 patients from nineteen different countries (twenty-two from High Income Countries or HICs, twelve from low- or middle-income countries, or LMICs) during the time period between 2000 to 2010.
Patients were studied in 5-year age groups (25 to 99 years old) to determine age-specific and sex-specific prevalence rates, Further, 15 PAD risk factors were studied to assess whether these played a role in delineating the respective prevalence in LMIC and HIC. Finally, regional estimates were calculated based upon prevalence derived from the patient data plus derivations of four factors found to have the highest associated odds for developing PAD (current smoking, hypertension, hypercholesterolemia, and diabetes).
Analysis revealed that the global prevalence of PAD has increased from 164 million in 2000 to 202 million in 2010 – an increase of 23.5%. The rise in PAD rates was most striking those greater that 80 years old, a group that saw increases greater than 35%. In 2010, 140.8 million of these patients with PAD (69.7% of world total) were in 2010 were living in LIMC regions (southeast Asia, western Pacific, Latin America, sub-Saharan Africa, eastern Mediterranean) while the remaining 61.3 million (30.3%) lived in Europe, and the high-income regions of the western Pacific and Americas. In HIC, male gender increased the risk of PAD diagnosis while in LMIC, PAD was consistently more prevalent in women across all age groups. Further analysis of other pertinent risk factors revealed significantly increased odds (OR >2) of PAD diagnosis with the presence of one the following risk factors: current smoking, former smoking, and history of another cardiovascular disease such as CHD and stroke; and moderately increased odds (OR 1.5-2.0) by diagnoses of diabetes, hypertension or hypercholesterolemia.
The authors acknowledged possible bias associated with limited mean lifespan in LMIC, smaller LMIC older age cohorts, worse survival of older age PAD patients in LMIC in comparison to HIC that is likely related to healthcare availability, and limited LMIC data.
By Philip Hewes and Mimme Kwong
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