Epidemiology of Peripheral Vascular Disease

1
Epidemiology of Peripheral Vascular Disease

• Sohail Ahmed
• School of Population and Health Sciences

2

• Peripheral vascular disease refers to a cluster
  of conditions in which narrowing and hardening of
  blood vessels occurs in the peripheral
  circulation, particularly in the legs. (modified
  from WHO definition)
• By far the commonest underlying pathology is
  Atherosclerosis.

3
Atherosclerosis
4
Risk Factors

• Non-modifiable
• Age (mid older)
• Male gender (upto age 65)
• Family history of hyperlipidaemia (1500)
• Race (e.g,African-Americans OR2.3) Criqui 2005.

• Modifiable
• High blood pressure
• Diabetes
• Smoking (Buergers disease)
• Hyperlipidaemia
• Obesity
• Excessive alcohol
• Sedentary life
• Stress depression
• Trauma

5
Clinical Features

• Asymptomatic
• Intermittent claudication
• Rest pain / critical ischaemia
• Ulcers / sepsis
• Gangrene

6
Asymptomatic

• Identified through random testing of population
  for research.
• Testing ABI in patients with other cardiovascular
  disease. (ABIlt0.9)

7
Intermittent Claudication

• Pain in the legs on walking a certain distance.
• Associated cardiovascular morbidity
• Disability (social consequences)
• Dependence on medicines.
• May require surgery
• 15 require amputation within 1 year (Martson
  2006)

8
Critical Ischaemia

• Rest pain (ABIlt0.5)
• Sleeplessness (Severe disability)
• Hospitalization
• 34 require amputation within 1 year (Martson
  2006)
• Acute on chronic episode leading to limb loss or
  death.

9
Ulcers

• 500,000 with recurrent leg ulcers in UK (10
  arterial)
• Disability
• Sepsis
• Frequent hospitalzation
• Surgical procedures
• Amputation
• Death

10
Gangrene

• Amputation
• High risk of mortality due to associated CVD.
• Mortality 20(1 yr), 40-70(5yr), 80-95(10yr).
• Burden on resources

11
Epidemiological Data

• Prevalence 7 to 15 in the middle aged and the
  elderly(Cuschieri 2002)
• 20 in over 75(Hiatt 1995)
• Coronary artery disease coexist in 68 Stroke
  coexist in 42 (Ness Aronow 1999)
• Classified alongwith other cardiovascular
  diseases it is the commonest cause of mortality
  in UK. (Males 300/100,000/yr, and Females
  190/100,000/yr)

• Amputation rate within one year of diagnosis is
  10-40(Dormandy 1999)
• Mortality after amputation
• 1 year 20
• 5 years 40 - 70
• 10 years 80 - 95
• Second most common cause of disability in the UK
  (WHO)
• Prevalent in deprived areas

12
Worldwide DistributionExclusive studies on PVD
were only conducted in USA Europe but its
prevalence can be directly translated from
cardiovascular mortality data from WHO (2005)
13
Distribution of Obesity
14
International Smoking Trends

• Although high across the world, it is inversely
  proportional to affluence.
• Number of deaths due to tobacco is equal in all
  countries but the burden of disease is much
  higher in developing countries.
• Buergers disease is only prevalent in
  Mediterranean, Eastern European and some Oriental
  countries.

15
Modifiable Risk Factors for UK Population

• Hypertension
• Smoking
• Excessive alcohol consumption
• Obesity hyperlipidaemia
• Diabetes mellitus
• Physical inactivity
• Factors associated with Ethnicity

16
Hypertension

• 20 of 16 were hypertensive in 1998.
• 80/1000 people in Eng Wales.
• Prevalence increasing (only 1/4th due to
  ageing).HSE
• 17 higher in females (after correcting for age)
• Twice as likely to die from CVA or CAD.
• Over 100,000 in Eng Wales suffer a first stroke
  every year.

• Risk factors other than ageing
• Obesity.
• Smoking.
• Lack of exercise.
• Excess of alcohol.
• Excessive salt
• intake.
• Diabetes mellitus.

17
Smoking

• Males 23
• Females 21 (ONS 2006)
• Trend decreasing since 1974.
• Strongly related to socio-economic class.
• Marked differences among different ethnic groups.

18
Excessive Drinking

• Recommended daily benchmark no more than 4
  units for men 3 units for women.
• Heavy drinking 8 units for men 6 units for
  women (at least one day during a week).
• Heavy drinkers
• Males 32
• Females 24
• age of people exceeding daily limit

19
Drinking in ethnic groups

• Adults drinking above the daily recommended limit
  by ethnic group and sex.

20
Obesity Physical Activity

• Obesity in England 2002
• Children 17
• Adults 23
• Increasing markedly
• No evidence to suggest any increase in caloric
  intake. (other factors?)
• Physical activity decreasing since early 1990s.

21
Diabetes mellitus

• 1.15 million with diabetes in Eng Wales in
  1998.
• From 1994 to 1998 there was 18 rise in
  prevalence in males and 20 rise in females.
• Prevalence higher in males.
• Account for 9 of annual hospital expenditure.
• Mortality significantly higher in diabetics.
• Mortality higher in lower socio-economic areas.
• More obese, diabetic patients in deprived areas.

22
Comments

• CAD is particularly prevalent in asians and
  stroke is prevalent in afro-carribeans. There is
  a need for better studies on assessing PVD/CVD in
  these groups.
• Early diagnosis of asymptomatic, high risk
  population is needed to prevent symptoms and
  reduce the burden of the disease.
• Need for increasing awareness among general
  public about the consequences of their
  lifestyles.
• Need for more extensive studies on PVD around the
  world to get a better understanding of the
  disease.

23

• Thank you