Commentary on ‘Peripheral Arterial Disease Incidence and Associated Risk Factors in a Mediterranean Population Based Cohort. The REGICOR Study’

Abstract

While the prevalence of peripheral arterial disease (PAD) is increasing globally, both in high, middle and low income countries, 1 this Spanish report from the Girona region shows the lowest incidence of PAD reported so far, 377/100,000 person years. 2 This author group has previously reported a PAD prevalence of 4.5% in the REGICOR study population, 3 while Baena-Diez 4 showed a corresponding incidence of 484/100,000 person years. These studies included men and women in the same age range (35e79 and 35e84 years of age, respectively). Interestingly, however, Merino 5 in a study from a corresponding Mediterranean area, including only the male population, 55e74 years of age, found an incidence of PAD of 2380/100,000 person years. Whether this great difference is only based on the age differences may be discussed, as the latter study did not include the oldest group (75e84 years), and also excluded the youngest population (35e54 years). Another explanation, the exclusion of the female population, also creates some doubt, as a male predominance is seen in the present paper, while other recent reports claim equality between genders or even a higher female incidence. 6 Likewise, all PAD, except intermittent claudication was shown to be more prevalent in women than in men in a Swedish study. 7 Previously reported data from the REGICOR study have shown a low incidence of myocardial infarction, despite a high prevalence of cardiovascular risk factors. 8 The present study points out the important role of the well known risk factors, specifically smoking and poorly controlled diabetes, the former as a higher risk in the older population, the latter at an earlier stage.The educational level is reported, but not discussed. Socioeconomic factors including educational level are known to be of importance. 9e11 The present material includes more than 50% with higher than elementary school education. Comparisons with other reports would be interesting as well as a study on covariation between risk factors and the educational level.The authors make a comment that almost 28% of the cohort was only followed up based on clinical records. There is no information on what proportion of subjects were complete "nonresponders". An underestimation of the incidence of PAD cannot be ruled out. However, from this and other studies it seems reasonable to conclude that the annual incidence of PAD is lower in the investigated Mediterranean region, despite a risk factor magnitude similar to the one found in other investigated areas. Comments on possible "preventive" factors would be of interest.