Comparison of Global Estimates of Prevalence and Risk Factors for Peripheral Artery Disease in 2000 and 2010: A Systematic Review and Analysis

Study Questions:

What are the differences in prevalence and risk factors for peripheral artery disease (PAD) among high-income countries (HIC), and low- or middle-income countries (LMIC), as well as the prevalence of PAD globally?

Methods:

The authors presented the results of a systematic review of the literature of community-based PAD studies since 1997, defining PAD as an ankle brachial index ≤0.90. Age- and sex-specific PAD rates were estimated with epidemiological modeling comparing HIC and LMIC, and then combining these estimates with United Nations population numbers for 2000 and 2010, to estimate global prevalence of PAD. A meta-analysis of odds ratios associated with 15 potential risk factors for PAD was performed in a subset of studies. These risk factors were used to predict PAD prevalence in eight World Health Organization regions.

Results:

The authors presented the results of their analysis on 34 community-based studies (22 from HIC and 12 from LMIC), which met inclusion criteria, including 112,027 subjects, of whom 9,347 had PAD. Globally, 202 million people were estimated to be living with PAD in 2010. This number increased in the preceding decade by 28.7% in LMIC, and 13.1% in HIC. Sex-specific prevalence rates increased with age and were broadly similar in HIC and LMIC. Prevalence of PAD in HIC at age 45-49 years was 5.28% (95% confidence interval [CI], 3.38-8.17%) in women and 5.41% (95% CI, 3.41-8.49%) in men. PAD prevalence in HIC at age 85-89 years was 18.38% (95% CI, 11.16-28.76%) in women and 18.83% (95% CI, 12.03-28.25%) in men. PAD prevalence in men was lower in LMIC than in HIC (2.89% [95% CI, 2.04-4.07%] at 45-49 years; and 14.94% [95% CI, 9.58-22.56%] at 85-89 years). The most potent risk factors for PAD were smoking (odds ratio [OR], 2.72; [2.39-3.09] in HIC; and 1.42; [1.25-1.62] in LMIC), followed by diabetes (OR, 1.88; [1.66-2.14] in HIC, and 1.47; [1.29-1.68] in LMIC), hypertension (OR, 1.55; [1.42-1.71] in HIC, and 1.36; [1.24-1.50] in LMIC), and hypercholesterolemia (OR, 1.39; [1.07-1.33] in HIC, 1.17; [1.03-1.25] in LMIC).

Conclusions:

The authors concluded that, in the 21st century, PAD has become a global problem. They further opined that governments, nongovernmental organizations, and the private sector in LMIC need to address the social and economic consequences, and assess the best strategies for optimum treatment and prevention of this disease.

Perspective:

This truly impressive statistical and meta-analysis review provides new and far more generalizable information about the prevalence of PAD, and the relationship to national income. On a global scale, the burden of PAD is tremendous. The statistical association with risk factors suggests that the prevalence of tobacco use is a powerful driver of PAD prevalence. It is fascinating to observe, for example, that while the positive association between age and PAD is unsurprising and persistent in both HIC and LMIC, there appears to be a much higher prevalence of PAD in HIC than LMIC for men. Also interesting, there was a higher prevalence of PAD in women versus men in LMIC. The causes of these differences are unclear, but certainly beg for further investigation of possible differential effects of socioeconomic factors. The take-home message, bolstered by extremely strong data, is the high prevalence and rapid growth in the number of people suffering with PAD globally.

Clinical Topics: Dyslipidemia, Prevention, Vascular Medicine, Homozygous Familial Hypercholesterolemia, Hypertension, Smoking

Keywords: Prevalence, Ankle Brachial Index, World Health Organization, Peripheral Arterial Disease, Risk Factors, Tobacco Use, Hypercholesterolemia, Hypertension, Smoking


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