Prevalence of peripheral arterial disease and its risk factos

Abstract

Introduction: Knowledge of the prevalence of peripheral arterial disease (PAD) is essential for health care policy maker and physicians in primary health care because of high mortality rate in affected individuals. Ankle-brachial index (ABI), the ratio of the ankle systolic pressure measured with a Doppler probe to that of the arm, is one of the diagnostic methods for PAD. Objective: To study the prevalence of PAD in the middle-class, urban Thai population. Design: Prospective, cross-sectional, descriptive study. Setting: The Electric Generating Authority of Thailand's head plant, Nonthaburi. Study Population: All employees and former employees who joined the first cardiovascular risk factors survey in 1985. Method: Blood samples were obtained for glucose, total cholesterol, high density lipoprotein cholesterol, and triglyceride. Then, the participants underwent history taking using a structured questionnaire, which had been sent to them prior to the survey, along with the letter of invitation. Before undergoing physical examination by a cardiologist, physician assistants measured their height, weight, blood pressure and ABI (the ratio of arterial pressures taken by a Doppler probe at the brachial arteries to that at both right and left dorsalis pedis and posterior tibial arteries). The diagnosis of PAD was made when an ABI taken at any of the ankle arteries was < 0.9. When all of the ABIs were >1.3, the patency of the artery could not be reliably assessed, so the participants with such findings were excluded from the analysis. Results: There were 2359 participants underwent the survey. ABI data were available on 2341 participants, 36 of whom fell into exclusion criteria, so 2305 were included in the analysis. There were 1724 (74.8%) men and 581 (25.2%) women aged 52.5-73.1 years (mean age 59.8+-4.9 years). The age-standardised prevalence of PAD was 3.88% in men and 9.00% in women. Of those with PAD only 9 (11.4%) had leg pain while walking and only 4 (5.1%) of these were typical of Rose intermittent claudication. The prevalent risk factors found with a descending order were hyperlipidaemia, hypertension, current smoking and diabetes. Multiple logistic regression analysis showed that hypertension (OR = 1.7), female gender (OR = 1.9), and current smoker (OR = 3.0) were statistically significant (p-value < 0.05), while current alcohol drinker (OR = 0.41) and BMI>25 kg/sq.m (OR = 0.54) appeared as protective factors. The association with PAD was not statistically significant for age (OR = 1.0) and diabetes (OR = 1.3). Conclusion: In comparison with the developed countries, the prevalence of PAD in the urban, middle-class Thais, was similar in women but lower in men. Current smoker and hypertension were the leading risk factors associated with PAD, while current alcohol drinker and BMI>25 kg/sq.m were protective.