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Epidemiology of Peripheral Vascular Disease

Epidemiology of Peripheral Vascular Disease. Sohail Ahmed School of Population and Health Sciences.

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Epidemiology of Peripheral Vascular Disease

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  1. Epidemiology of Peripheral Vascular Disease Sohail Ahmed School of Population and Health Sciences

  2. Peripheral vascular disease refers to a cluster of conditions in which narrowing and hardening of blood vessels occurs in the peripheral circulation, particularly in the legs. (modified from WHO definition) • By far the commonest underlying pathology is Atherosclerosis.

  3. Atherosclerosis

  4. Non-modifiable: Age (mid & older) Male gender (upto age 65) Family history of hyperlipidaemia (1:500) Race (e.g,African-Americans OR=2.3)Criqui 2005. Modifiable: High blood pressure Diabetes Smoking (Buerger’s disease) Hyperlipidaemia Obesity Excessive alcohol Sedentary life Stress & depression Trauma Risk Factors

  5. Clinical Features • Asymptomatic • Intermittent claudication • Rest pain / critical ischaemia • Ulcers / sepsis • Gangrene

  6. Asymptomatic • Identified through random testing of population for research. • Testing ABI in patients with other cardiovascular disease. (ABI<0.9)

  7. Intermittent Claudication • Pain in the legs on walking a certain distance. • Associated cardiovascular morbidity • Disability (social consequences) • Dependence on medicines. • May require surgery • 15% require amputation within 1 year (Martson 2006)

  8. Critical Ischaemia • Rest pain (ABI<0.5) • Sleeplessness (Severe disability) • Hospitalization • 34% require amputation within 1 year (Martson 2006) • Acute on chronic episode leading to limb loss or death.

  9. Ulcers • 500,000 with recurrent leg ulcers in UK (10% arterial) • Disability • Sepsis • Frequent hospitalzation • Surgical procedures • Amputation • Death

  10. Gangrene • Amputation • High risk of mortality due to associated CVD. • Mortality 20%(1 yr), 40-70%(5yr), 80-95%(10yr). • Burden on resources

  11. Prevalence 7% to 15% in the middle aged and the elderly(Cuschieri2002) 20% in over75(Hiatt 1995) Coronary artery disease coexist in 68% & Stroke coexist in 42%(Ness & Aronow 1999) Classified alongwith other cardiovascular diseases it is the commonest cause of mortality in UK. (Males 300/100,000/yr, and Females 190/100,000/yr) Amputation rate within one year of diagnosis is 10-40%(Dormandy 1999) Mortality after amputation: 1 year = 20% 5 years = 40% - 70% 10 years = 80% - 95% Second most common cause of disability in the UK (WHO) Prevalent in deprived areas Epidemiological Data

  12. Worldwide DistributionExclusive studies on PVD were only conducted in USA & Europe but its prevalence can be directly translated from cardiovascular mortality data from WHO (2005)

  13. Distribution of Obesity

  14. International Smoking Trends • Although high across the world, it is inversely proportional to affluence. • Number of deaths due to tobacco is equal in all countries but the burden of disease is much higher in developing countries. • Buerger’s disease is only prevalent in Mediterranean, Eastern European and some Oriental countries.

  15. Modifiable Risk Factors for UK Population • Hypertension • Smoking • Excessive alcohol consumption • Obesity & hyperlipidaemia • Diabetes mellitus • Physical inactivity • Factors associated with Ethnicity

  16. 20% of 16+ were hypertensive in 1998. 80/1000 people in Eng & Wales. Prevalence increasing (only 1/4th due to ageing).HSE 17% higher in females (after correcting for age) Twice as likely to die from CVA or CAD. Over 100,000 in Eng & Wales suffer a first stroke every year. Risk factors other than ageing Obesity. Smoking. Lack of exercise. Excess of alcohol. Excessive salt intake. Diabetes mellitus. Hypertension

  17. Smoking • Males 23% Females 21% (ONS 2006) • Trend decreasing since 1974. • Strongly related to socio-economic class. • Marked differences among different ethnic groups.

  18. Excessive Drinking • Recommended daily benchmark – no more than 4 units for men & 3 units for women. • Heavy drinking – 8 units for men & 6 units for women (at least one day during a week). • Heavy drinkers Males 32% Females 24% • %age of people exceeding daily limit

  19. Drinking in ethnic groups • Adults drinking above the daily recommended limit by ethnic group and sex.

  20. Obesity & Physical Activity • Obesity in England 2002 Children 17% Adults 23% • Increasing markedly • No evidence to suggest any increase in caloric intake. (other factors?) • Physical activity decreasing since early 1990s.

  21. Diabetes mellitus • 1.15 million with diabetes in Eng & Wales in 1998. • From 1994 to 1998 there was 18% rise in prevalence in males and 20% rise in females. • Prevalence higher in males. • Account for 9% of annual hospital expenditure. • Mortality significantly higher in diabetics. • Mortality higher in lower socio-economic areas. • More obese, diabetic patients in deprived areas.

  22. Comments • CAD is particularly prevalent in asians and stroke is prevalent in afro-carribeans. There is a need for better studies on assessing PVD/CVD in these groups. • Early diagnosis of asymptomatic, high risk population is needed to prevent symptoms and reduce the burden of the disease. • Need for increasing awareness among general public about the consequences of their lifestyles. • Need for more extensive studies on PVD around the world to get a better understanding of the disease.

  23. Thank you

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