Peripheral Arterial Disease – Underestimated Non-Communicable Disease

Peripheral arterial disease (PAD) is a disease characterised by progressive thickening of the walls of arteries by fat deposits and subsequently limitation the flow of oxygen-rich blood to organs and limbs. This causes symptoms, most notably leg pain when walking (intermittent claudication). Progression of arterial changes leads to rest pain and biological tissue loss (gangrene). If revascularisation procedures are not possible it leads to amputation and this way to dramatically decrease quality of life. The prevalence of PAD in general population is 12–14%, affecting up to 20% of those over 70. (70%–80% are asymptomatic). PAD affects 1/3 of diabetics over the age of 50. Of patients with intermittent claudication, only 7% will undergo lower extremity bypass surgery, 4% major amputations, and 16% worsening claudication, but stroke and heart attack events are elevated, and the 5-year mortality rate is estimated to be 30% (versus 10% in controls). The Ankle Brachial Pressure Index (ABPI) test is a similar and cheap tool for the non-invasive assessment of PAD with 90% sensitivity and 98% specificity for detecting hemodynamic significant stenosis of major leg arteries. We use ultrasound blood flow detector - Doppler probe and a sphygmomanometer. 24 general practitioners from all regions of Slovakia assessed 2207 consecutive patients over 60 years.  67,4 % of patients had normal ABPI 0,9-1,2.   9,4 % of patients had decreased ABPI < 0,9 and 23,2 % of patients ABPI > 1,2. By questionnaire of risk factors and complications we detected that patients with decreased ABPI have significantly increased risk of myocardial infarction and stroke. Decreased ABPI is more often in men, smokers, diabetics, suffered by high blood pressure, patients with dyslipidemia and people with lower education. These people are at high risk of  stroke and heart attack events so they need further active management of risk factors.