Burden of PAD: A Moving Target

Author : Dr. Jasmin Melissa Bernardo

PAD or peripheral arterial disease in this article will be

used to label stenosis or blockages of the arteries f the legs

which is solely due to atherosclerosis. Other blockages of the arteries of the legs may arise from cardioemblolic event or vasculitides. Some common beliefs of doctors about PAD needs to be debunked, like PAD is not common among Asians or that it is a predominantly male disease, that it is not as serious as coronary artery disease or stroke and that we don’t haave to treat them.

In a 2013 population study from UK and US, they found that worldwide, low income countries are more widely affected than high income countries and that it is also as common among females than males. In fact in the REACH registry, they found that the incidence of CV death, MI or stroke or hospitalization for atherothrombotic events were highest among PAD patients (21.14% vs 15.2% CAD; 14.53% CVD). In a US census in 2004, the vascular related hospitalization cost was in excess of 21 billion USD. Overall PAD prevalence has grown faster in the past 10 years with increase of up to 25% from 164 million cases in 2000 to 201 million cases in 2010 worldwide.

Who are at risk for lower extremity PAD?:

1. age les than 50 y/o with diabetes mellitus and one additional risk factor (e.g.smoking, dyslipidemia, hypertension, hyperhomocysteinemia)

2. age 50 to 69 y/o with a history of smoking or diabetes

3. >70 y/o

4. leg symptoms with exertion (suggestive of claudication) or ischemic rest pain

5. abnormal lower extremity pulse examination

6. known CAD, carotid disease or renal artery stenosis

The natural history of PAD is dismal with ¾ the of severe PAD patients dead at 10

years.

In the Prevalence of Atherosclerosis related risk factors and disease in the Philippine Study by Sy,Rody, Morales, et al, PAD in general population in 2008 went up from 0.6% to 1.0%. In the PHC data, most of patients with PAD present with emergent symptoms of

either critical limb or sepsis from gangrene or non healing wound. More than half end up losing their leg even with attempts to revascularize and ¼ die because of CV complications during admission. Thus we are treating them too late and doing too

little to prevent it, a fart more costly strategy than promoting education, advocacy and prevention. A leg bypass cost around 350K to 500K while amputation costs 50k to 150k while prevention cost as little as nothing. The call for leg health among Filipinos begins with education of both doctors and patients. Preventive strategy advocates screening of high risk population,controlling known risk factors like smoking, hypertension, diabetes and dyslipidemia as well as encouraging healthy lifestyle habits that includes balanced

good diet and life long regular exercise. So to our colleagues, lets keep moving and lets walk to circulate.