Epidemiology of Peripheral Vascular Disease - research.ncl.ac ...

Epidemiology of Peripheral Vascular Disease - research.ncl.ac ...

Epidemiology of Peripheral Vascular Disease Sohail Ahmed School of Population and Health Sciences 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. Atherosclerosis Risk Factors Non-modifiable: 1. Age (mid & older) 2. Male gender (upto age 65) 3. Family history of hyperlipidaemia (1:500)

4. Race (e.g,African-Americans OR=2.3) Criqui 2005. Modifiable: 1. High blood pressure 2. Diabetes 3. Smoking (Buergers disease) 4. Hyperlipidaemia 5. Obesity 6. Excessive alcohol 7. Sedentary life 8. Stress & depression 9. Trauma Clinical Features Asymptomatic Intermittent claudication Rest pain / critical ischaemia Ulcers / sepsis

Gangrene Asymptomatic Identified through random testing of population for research. Testing ABI in patients with other cardiovascular disease. (ABI<0.9) 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) Critical Ischaemia Rest pain (ABI<0.5) Sleeplessness (Severe disability) Hospitalization 34% require amputation within 1 year

(Martson 2006) Acute on chronic episode leading to limb loss or death. Ulcers 500,000 with recurrent leg ulcers in UK (10% arterial) Disability Sepsis

Frequent hospitalzation Surgical procedures Amputation Death Gangrene Amputation High risk of mortality due to associated CVD. Mortality 20%(1 yr), 4070%(5yr), 80-95%(10yr). Burden on resources

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

Mortality after amputation: 1 year = 20% 5 years = 40% - 70% 10 years = 80% - 95% Second most common cause of disability in the UK (Dormandy 1999) 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% (WHO) Prevalent in deprived areas Worldwide Distribution Exclusive studies on PVD were only conducted in USA & Europe but its prevalence can be directly translated from cardiovascular mortality data from WHO (2005) Nigeria Mortality due to CVD & diabetes (all ages) Nigeria Pakistan

India France China Canada U.K USA Russia CVD D.M WHO 2005. Estim. Loss of national income in 2005 11% 22% 28% 31% 33% 34%

38% 38% 61% 1% 1% 2% 2% 1% 3% 1% 3% 0% $ 400 m $1b $9b $? $ 18 b $ 500 m $2b

$? $ 11 b Pakistan India France CVD China D.M Canada UK USA Russia 0 20 40

60 80 Distribution of Obesity 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.

Nigeria Pakistan India France China fem ales m ales Canada UK Buergers disease is only prevalent in Mediterranean, Eastern European and some Oriental countries. USA Russia

0 20 40 60 Modifiable Risk Factors for UK Population Hypertension Smoking Excessive alcohol consumption

Obesity & hyperlipidaemia Diabetes mellitus Physical inactivity Factors associated with Ethnicity 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. Smoking Males 23% Females 21% (ONS 2006) Trend decreasing since 1974. Strongly related to socio-economic class. Marked differences among different ethnic groups. 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

Drinking in ethnic groups Adults drinking above the daily recommended limit by ethnic group and sex. 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. 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 socioeconomic areas. More obese, diabetic patients in deprived areas. 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. Thank you

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