Disparities in Diagnosis, Treatment, Outcomes of PAD: Key Points

McDermott MM, Ho, KJ, Alabi O, et al.
Disparities in Diagnosis, Treatment, and Outcomes of Peripheral Artery Disease: JACC Scientific Statement. J Am Coll Cardiol 2023;82:2312-2328.

The following are key points to remember from a JACC Scientific Statement on disparities in diagnosis, treatment, and outcomes of peripheral artery disease (PAD):

  1. Lower extremity PAD affects approximately 230 million people worldwide, 8.5 million in the United States.
  2. Compared to people without PAD, those with PAD have higher rates of cardiovascular events, major adverse limb events, greater walking impairment, increased mobility loss, and poorer quality of life.
  3. In people with PAD, disparities in prevalence, diagnosis, treatment, and outcomes by sex, race, geography, and socioeconomic status contribute to adverse outcomes.
  4. In the United States, Black people have approximately twice the rate of PAD as other racial and ethnic groups. This difference is not fully explained by differences in traditional risk factors (e.g., hypertension, dyslipidemia, cigarette smoking, and diabetes).
  5. Rates of amputation are markedly higher among Black versus non-Black people with PAD. Hispanic and Native American people with PAD also have higher rates of amputation when compared to White people with PAD.
  6. Guidelines recommend cholesterol-lowering therapy for patients with PAD. However, women and Black people are less likely than men to be prescribed this therapy than men and non-Black people with PAD.
  7. Diabetes mellitus is an important risk factor for PAD development, severity, and complications. Individuals at lower socioeconomic status, which disproportionately impacts Black populations, have poor access to healthy foods and expensive diabetes medications (e.g., SGLT2 inhibitors, GLP1 agonists) that have shown improvement in PAD and cardiovascular outcomes.
  8. Antiplatelet therapy, including dual pathway inhibition (rivaroxaban 2.5 mg twice daily plus aspirin 81 mg daily) can reduce cardiovascular and limb-specific event rates for people with PAD. However, Black people with PAD are less likely to receive antiplatelet therapy and higher costs with dual pathway inhibition limit its widespread adoption.
  9. Supervised walking exercise and structured home-based walking exercise have been shown to improve mobility and walking distance. However, women and Black people are less likely to be referred to supervised exercise therapy than men and non-Black people. Structured home-based walking programs are not widely available in the United States.
  10. Race is a social construct and a proxy for racism and inequitable distribution of resources, which results in adverse health consequences. Effective strategies to overcome disparities in PAD diagnosis, treatment, and outcomes must be mindful of the social and political factors that contribute to health disparities, including those for people with PAD.
  11. Proposed solutions to reduce disparities in PAD include increased knowledge among clinicians about these disparities, increased awareness among marginalized populations about typical and atypical symptoms of PAD, enacting policies that ensure access to affordable and effective treatments for all people with PAD, and improving access to healthy foods and effective medical therapies.
  12. The PAD National Action Plan includes six key goals: 1) increased public awareness; 2) improved professional education; 3) improved detection and treatment; 4) public health interventions; 5) increased and sustained research funding; and 6) coordinated advocacy efforts.

Clinical Topics: Vascular Medicine, Atherosclerotic Disease (CAD/PAD), Prevention

Keywords: Healthcare Disparities, Peripheral Arterial Disease

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