Top Things to Know: Health Disparities in PAD
Published: June 15, 2023
Prepared by Barbara Entl, MD Science and Medicine Advisor
- Peripheral artery disease (PAD) is a progressive atherosclerotic disease in which one or more peripheral arteries are partially or completely obstructed.
- PAD affects over 12 million Americans and significantly impacts the quality of life as it carries the potential for a loss of limb, and presents high mortality risk, particularly with advanced disease.
- Individuals diagnosed with lower extremity PAD may also have concomitant disease in other vascular territories. Prior studies have demonstrated a relatively high prevalence of a coronary and cerebrovascular disease among patients with PAD.
- In the United States, certain demographic groups experience higher prevalence and clinical impact of peripheral artery disease.
- In studies evaluating multi-ethnic populations, Black Americans were found disproportionally affected by PAD. They present with an increased risk of amputation, more advanced chronic limb-threatening ischemia, including gangrene or foot sepsis, lower ankle-brachial index, increased arterial stiffness, small vessel disease, and more severe infrapopliteal disease across socioeconomic strata, as compared with other groups.
- Among Hispanic subgroups, Cuban Americans have the highest risk of PAD compared to Mexican Americans, followed by Puerto Rican Americans, those with a Central American background, and Dominican Americans.
- The reasons behind the inequitable burden of PAD are both multifactorial and complex in nature. The key risk factors for PAD, including smoking, diabetes, hypertension, and dyslipidemia, may be important contributors; however, social determinants appear to play a central role. Prevalence studies show higher rates of PAD with lower income, lower education levels, and less social support with a higher risk for amputation with lower socioeconomic status.
- Evidence suggests pathophysiological drivers of the clinical expression of PAD also differ across self-reported race and ethnicity. Several studies document accentuation of vascular aging with reduced endothelial function, increased arterial stiffness, and increased oxidative stress in Black Americans and some studies of Hispanic Americans.
- Mitigating the effects of differences in the outcomes of PAD is a multifaceted challenge and needs to begin with the structural differences in the way health care is provided. More efficient delivery of low-cost preventive measures, such as hemoglobin A1c testing, vascular assessment of circulation, and diabetic foot exams may help to limit overall PAD spending in the long run, by preventing problems before they occur.
- The current statement provides a further overview of the variables that contribute to PAD disparities and offers opportunities to mitigate these disparities by identifying existing knowledge gaps, highlighting future investigational research targets, and offering potential structural solutions.
Citation
Allison MA, Armstrong DG, Goodney PP, Hamburg NM, Kirksey L, Lancaster JK, Mena-Hurtado CI, Misra S, Treat-Jacobson DJ, White Solaru KT; on behalf of the American Heart Association Council on Peripheral Vascular Disease; Council on Hypertension; and Council on Lifestyle and Cardiometabolic Health. Healthdisparities in peripheral artery disease: a scientific statement from the American Heart Association [published online ahead of print June 15, 2023]. Circulation. doi: 10.1161/CIR.0000000000001153