Peripheral arterial disease prevalence and associated risk factors in the mediterranean population

Abstract

The manifestation of atherosclerosis in the lower extremities is known as peripheral arterial disease (PAD), this disease leads to a narrowing of the artery thus restricting blood flow to this area. PAD is one of the leading causes of cardiovascular pathology and an important indicator of cardiovascular risks due to its association to other cardiovascular diseases. It is estimated that after 5 years, 20% of patients with PAD have associated coronary heart disease or cerebrovascular events with mortality rates between 10-15%. Therefore, PAD is an important indicator of cardiovascular morbid mortality. The overall global prevalence of PAD has shown an increase of 17% from 2010-2015 estimating 237 million cases worldwide, with PAD screening suggested at 65 years old in American guidelines. This expresses the importance of early diagnosis in these subjects to aid and prevent associated cardiovascular diseases. An overall worldwide increase in prevalence of PAD has been observed in the last few years creating a general concern because of the associated risk with other cardiovascular disease and mortality. PAD can be asymptomatic in most cases and present with atypical symptoms as seen in women, delaying its diagnosis. We also know due to its atherosclerotic nature; its prevalence increases with age and varies with demographic region. Being aware of the prevalence of PAD in your region can be an important tool to help develop preventative strategies and provide an early and perhaps more effective diagnosis and treatment. We hypothesize that the prevalence of PAD will be higher than shown in other studies in our region because these studies tend to include younger age groups who consequently have fewer risk factors. We believe these studies might not reflect our current reality in Barcelona Nord due to our population base, being of a higher age. Our primary objective: is to determine the overall prevalence of PAD in 65-year-olds in our area of treatment, Barcelona Nord. Secondary objectives: are to determine the difference in prevalence's in males and females as well as to identify their associated risk factor and assess their cardiovascular risk in the next 10 years. This study was a single center, population based, cross sectional in which we analysed all asymptomatic men and women of 65 years in age in our area of treatment, Barcelona Nord. We evaluated common cardiovascular risk factors, performed a physical exam evaluating distal pulses and in all participants an ankle brachial index (ABI) was performed. Those ABI< 0. 9 mmHg were considered to have peripheral arterial disease. All participants whom an ABI could not be performed due to skin ulcers or limb amputations were excluded. We had total of 2. 808 subjects were 65 years old during the time of recruitment, 1. 174 subjects were finally included, 59. 2% male and 40. 8% females. The prevalence for PAD in Barcelona Nord in individuals of 65 years was 6. 2% (95% CI: 4. 8-7. 6%), male 7. 9% (95% CI: 5. 9-9. 9%) and female 3. 8% (95% CI: 2. 1-5. 5%). Male subjects who were smokers and diabetic were more likely to have PAD (p = 0. 017) and female subjects who were smokers and had hypertension (p = 0. 026). Conclusion Overall prevalence of PAD in our region was relatively lower than the prevalence in other parts of Europe and concurred with prevalence's estimated in other Catalunya regions. We found that in our population base study, hypertensive smoking women and diabetic smoking men had a strong association for developing PAD. These results shift our focus in these subgroups of individuals, knowing that in these cases perhaps ABI screening programs and secondary preventive measures could have an important role in diagnosing and preventing this pathology in our area of treatment, Barcelona Nord.

Date of Award	9 Dec 2024
Original language	English
Supervisor	Sergio Bellmunt Montoya (Director)