Peripheral Arterial Disease
- Peripheral arterial disease (PAD) is an important vascular disease and is an indicator of widespread atherosclerosis in other vascular territories, such as the cerebral and coronary circulations. People with PAD have considerable mortality, morbidity and is also associated with increased rates of hospitalization and reduced quality of life.
- It is frequently seen in association with other vascular diseases such as coronary artery disease (CAD), stroke, and diabetes.1
- Diabetes, hypertension, smoking and dyslipidemia are the major modifiable risk factors for the development of PAD as well as CAD in Europids.1 Despite having high prevalence of some of these CAD risk factors, the prevalence of PAD is disproportionately low in South Asian population.1-3 However some studies have shown similar prevalence.4
- In a population based study from India, the overall prevalence of PAD (as diagnosed by Ankle Brachial Pressure Index or ABPI of<0.9) was 3%, which is considerably lower than the prevalence (6–18%) in Europids.5, 6 Unlike Europids PAD is not correlated with CAD among Indians; the prevalence of CAD was similar in people with and without PAD.6
- In the UK, lower extremity amputations (LEA) among South Asians with diabetes were 75% lower than that of their Europid counterparts which in turn may be due to low rates of PAD and neuropathy. 2
- The finding of low incidence of PAD in South Asian people is unclear and genetic factors may be involved. Its worth noting that PAD is also less common in Caribbean blacks with diabetes unlike African Americans.2, 7
- Old age is one of the important risk factors for PAD and South Asians may not be living long enough to develop PAD due to the premature mortality from CAD.
Sources
1. Bennett PC, Silverman S, Gill PS, Lip GY. Ethnicity and peripheral artery disease. QJM. Jan 2009;102(1):3-16.
2. Chaturvedi N, Coady E, Mayet J, et al. Indian Asian men have less peripheral arterial disease than European men for equivalent levels of coronary disease. Atherosclerosis. Jul 2007;193(1):204-212.
3. Mohan V, Vijayaprabha R, Rema M. Vascular complications in long-term south Indian NIDDM of over 25 years’ duration. Diabetes Res Clin Pract. Mar 1996;31(1-3):133-140.
4. Bennett PC, Lip GY, Silverman S, Blann AD, Gill PS. The contribution of cardiovascular risk factors to peripheral arterial disease in South Asians and Blacks: a sub-study to the Ethnic-Echocardiographic Heart of England Screening (E-ECHOES) study. QJM. Sep 2010;103(9):661-669.
5. Mohan V, Premalatha G, Sastry NG. Peripheral vascular disease in non-insulin-dependent diabetes mellitus in south India. Diabetes Res Clin Pract. Mar 1995;27(3):235-240.
6. Premalatha G, Shanthirani S, Deepa R, Markovitz J, Mohan V. Prevalence and risk factors of peripheral vascular disease in a selected South Indian population: the Chennai Urban Population Study. Diabetes Care. Sep 2000;23(9):1295-1300.
7. Singh S, Bailey KR, Kullo IJ. Ethnic differences in ankle brachial index are present in middle-aged individuals without peripheral arterial disease. Int J Cardiol. Jun 6 2011.