ArticlesComparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis
Introduction
Chronic non-communicable diseases (NCDs) are now the leading cause of morbidity and mortality not only in high-income countries (HIC), but also in low-income or middle-income countries (LMIC).1, 2 Over the next decade, the global burden of NCDs will grow rapidly, driven mainly by an ageing world population and increased exposure to chronic disease risk factors in LMIC.3, 4 The global pandemic of NCDs was the main topic of a UN high-level meeting in 2011.5 One of the first tasks required for a coordinated and cost-effective response is to quantify the current burden of the most important NCDs and their global and regional spread. This effort will probably be met with a paucity of information from most LMIC, which will be particularly true for diseases that are still relatively neglected even in HIC. One of the best examples is lower limb peripheral artery disease, the third leading cause of atherosclerotic vascular morbidity after coronary heart disease and stroke. About 10–20% of people with peripheral artery disease have intermittent claudication,6, 7 another 50% have atypical leg symptoms,7 and those without exertional leg pain have poor mobility compared with individuals without peripheral artery disease.8 Patients with and without leg ischaemic symptoms have roughly a three-fold increase in risk of mortality and major cardiovascular events (heart attack and stroke) compared with those without peripheral artery disease.9, 10, 11
To develop effective policies and programmes for the global prevention and management of peripheral artery disease, population surveillance data and studies of risk factors are crucial, but lacking in many HIC and particularly in LMIC. Currently, there are no reliable estimates of the global prevalence of peripheral artery disease. Moreover, in assessing the global transition in cardiovascular disease in recent years,12 attention has been focused on the decline in coronary heart disease and stroke in HIC, the corresponding increase in many LMIC, and the risk factors that might be driving this change.13, 14 Little attention has been paid to peripheral artery disease.
We did a rigorous systematic analysis of all the evidence available in the public domain to identify epidemiological studies of peripheral artery disease of acceptable quality. Using the information from those studies, we aimed to: (1) provide the first comparison of age-specific and sex-specific prevalence of peripheral artery disease between HIC and LMIC; (2) establish the main risk factors for peripheral artery disease in HIC and LMIC; and (3) provide robust estimates of the number of people living with peripheral artery disease regionally and globally.
Section snippets
Study design
The methods consisted of the following stages: (1) literature search for studies on prevalence of peripheral artery disease; (2) extraction of data from these studies; (3) modelling of age-specific and sex-specific prevalence in HIC and LMIC based on the extracted data; (4) application of age-specific and sex-specific prevalence data to UN Population Division's populations15 in HIC and LMIC to provide estimates of numbers of individuals living with peripheral artery disease in 2000 and 2010;
Results
The initial screening retrieved 7489 titles of articles, 588 of which indicated a possible population-based study of cardiovascular disease (figure 1), and 243 had any mention of peripheral artery disease. These 243 full-text articles were then reviewed independently by two assessors and retained after discussion and agreement. We identified 2074 articles in the additional regional search. Of the 113 articles critically reviewed, 34 were included in this study.
The 34 retained studies on
Discussion
This study presents the first comprehensive, data-driven estimates of the global epidemiology of peripheral artery disease, and the differences between HIC and LMIC. As expected, prevalence of peripheral artery disease increased with age in both settings, from a relatively uncommon disorder in people younger than 40 years to a common problem affecting one in ten people aged 70 years, and one in six people older than 80 years. We retrieved sufficient information from both HIC and LMIC to
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