Risk factors of peripheral arterial disease: a case control study in Sri Lanka

Abstract

BackgroundPeripheral artery disease (PAD) is an important global health problem and contributes to notable proportion of morbidity and mortality. This particular manifestation of systemic atherosclerosis is largely under diagnosed and undertreated. For sustainable preventive strategies in a country, it is mandatory to identify country-specific risk factors. We intended to assess the risk factors of PAD among adults aged 40–74 years.MethodsThis case control study was conducted in 2012–2013 in Sri Lanka. Seventy-nine cases and 158 controls in the age group of 40–74 years were selected for the study in order to have case to control ratio 1:2. The criterion for selecting cases and control was based on Ankle brachial pressure index (ABPI). Cases were selected from those who had ABPI 0.85 or less (ABPI ≤0.85) in either lower limb. Controls were selected from those ABPI score between 1.18 and 1.28 in both lower limbs. Only newly identified individuals with PAD were selected as cases. Controls were selected from the same geographical location and within the 5 year age group as cases.ResultsThe history of diabetes mellitus more than 10 years (OR 5.8, 95% CI 2.2–14.2), history of dyslipidemia for more than 10 years (OR 4.9, 95% CI 2.1–16.2), history of hypertension for more than 10 years (OR 3.8, 95% CI 1.8–12.7) and smoking (OR 2.9, 95% CI 1.2–6.9), elevated HsCRP (OR 3.7, 95% CI 1.2–12.0) and hyperhomocysteinemia (OR 3.0, 95% CI 1.1–8.1) were revealed as country specific significant risk factor of PAD.ConclusionsDiabetes mellitus, hypertension, dyslipidemia, smoking as well as elevated homocysteine and HsCRP found as risk factors of PAD. Longer the duration or higher level exposure to these risk factors has increased the risk of PAD. These findings emphasis the need for routine screening of PAD among patients with the identified risk factors.

Ankle-brachial index and peripheral arterial disease: An evaluation including a type 2 diabetes mellitus drug-naïve patients cohort

“…A few previous researches suggested that time of disease should remain a risk factor even for patients who were still young when diagnosed. 14,15 The importance of this risk factor, associated with the high prevalence of PAD in early diagnosed drug-naïve T2DM patients, just confirms the existence of a delay to detect that disease. 16 In addition, Faglia et al, in a recent cross-sectional study with a larger number of newly diagnosed type 2 diabetes patients in Italy, showed that 21% of these already had ABI ⩽0.9, reinforcing our findings.…”

“…In addition, another possible explanation could be that diabetic patients often have distal arterial disease (such as tibial) rather than proximal disease (such as iliac), the one associated with smoking. Finally, Weragoda et al 15 pointed not only DM, hypertension, dyslipidaemia and smoking as principal risk factors for PAD but also its lack of awareness, which leads to delayed diagnosis, low compliance and unfavourable outcomes. Therefore, measuring ABI as early as possible in all T2DM patients becomes more imperative.…”

Two-dimensional system based on organic and functional impairment with aging for precisely assessing risk factors in chronic disease

“…The original BA is relatively uncontrollable and mainly represents natural aging. The functional BA in this study is calculated with hypertension and obesity; the latter is also associated with many chronic diseases in both genetic and external factors [32,[39][40][41]; we considered functional BA as disease-associated aging for this reason. The risks for chronic diseases from aging and other factors could be discriminated through the two-dimensional system based on two BAs.…”

Percutaneous transluminal lower limb angioplasty [PTA] for chronic limb threatening ischaemia [CLTI] in a low resource setting - 4 year experience

“…With the emergence of diabetes mellitus, there is a significant burden of peripheral occlusive arterial disease [POAD] in Sri Lanka [1]. The age-sex standardized prevalence of diabetes mellitus for Sri Lankans aged 20 years and above was 10.3% [2].…”