Prevalence of and risk factors for peripheral artery disease in rural South Africa: A cross-sectional analysis of the HAALSI cohort

Abstract

Introduction. The burden of peripheral artery disease (PAD) is increasing in low- and middle-income countries. Existing literature from sub-Saharan Africa is limited and lacks population-representative estimates. We estimated the burden and risk factor profile of PAD for a rural South African population. Methods. We used data from 1,883 participants of the HAALSI cohort of South African adults aged 40-69 years with available ankle-brachial index (ABI) measurements. We defined clinical PAD as ABI ?0.90 or >1.40 and borderline PAD as ABI >0.90 & ?1.00. We compared the distribution of sociodemographic variables, biomarkers, and comorbidities across PAD classifications. To identify associated factors, we calculated unadjusted and age-sex-adjusted prevalence ratios with log-binomial models. Results. Overall, 6.6% (95% CI: 5.6-7.7) of the sample met the diagnostic criteria for clinical PAD while 44.7% (95% CI: 42.4-47.0) met the diagnostic criteria for borderline PAD. Age (PR: 1.9, 95% CI: 1.2-3.1 for ages 50-59 compared to 40-49; PR: 2.5, 95% CI: 1.5-4.0 for ages 60-69 compared to 40-49) and C-reactive protein (PR: 1.08, 95% CI: 1.03-1.12) were associated with increased prevalence of clinical PAD. All other examined factors were not associated with clinical PAD. Conclusions. We found high PAD prevalence for younger age groups compared to previous research and a lack of evidence for the influence of traditional risk factors for this rural, low-income population. Future research should focus on identifying the underlying risk factors for PAD in this setting. South African policymakers and clinicians should consider expanded screening for early PAD detection in rural areas.

"Evaluation of Asymptomatic Lower Limb Obliterating Arteriopathy and Associated Cardiovascular Risk Factors in the Senegalese Population Using the Systolic Pressure Index Method"

“…It is well established that the cardiovascular risk increases with age and advanced age is considered as a factor independently linked to PAD in several studies. The study conducted at the emergency department of the Melbourne University Hospital showed that the prevalence of PAD increased significantly with age (25.7% [95% CI: 17.0-36.7]) [26]. The ELLIPSE study showed using a multivariate analysis that advanced age ≥ 81 years was an independent factor of PAD with an OR of 1.45 [27].…”