Peripheral Arterial Disease in Sub-Saharan Africa

Johnston, Lily E.; Stewart, Barclay T; Yangni-Angate, H; Veller, Martin; Upchurch, Gilbert R.; Gyedu, Adam; Kushner, Adam L.

doi:10.1001/jamasurg.2016.0446

Cited by 30 publications

(32 citation statements)

References 59 publications

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“…Since 1990, the prevalence, incidence, and mortality have increased worldwide, with the steepest increases seen in SSA [2]. An excellent systematic review in SSA revealed a high burden of morbidity from PAD, diagnosed by an ankle-brachial index (ABI) of <0.9, where prevalence ranged from 3.1% to 24% of adults aged 50 years and older and 39% to 52% of individuals with known risk factors like diabetes and smoking [111]. The findings of community prevalence rates in SSA are similar to high-income countries [112].…”

Section: Peripheral Artery Diseasementioning

confidence: 99%

Cardiovascular Diseases in Sub-Saharan Africa Compared to High-Income Countries: An Epidemiological Perspective

et al. 2020

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Non-communicable diseases (NCDs) are the second common cause of death in sub-Saharan Africa (SSA) accounting for about 35% of all deaths, after a composite of communicable, maternal, neonatal, and nutritional diseases. Despite prior perception of low NCDs mortality rates, current evidence suggests that SSA is now at the dawn of the epidemiological transition with contemporary double burden of disease from NCDs and communicable diseases. In SSA, cardiovascular diseases (CVDs) are the most frequent causes of NCDs deaths, responsible for approximately 13% of all deaths and 37% of all NCDs deaths. Although ischemic heart disease (IHD) has been identified as the leading cause of CVDs mortality in SSA followed by stroke and hypertensive heart disease from statistical models, real field data suggest IHD rates are still relatively low. The neglected endemic CVDs of SSA such as endomyocardial fibrosis and rheumatic heart disease as well as congenital heart diseases remain unconquered. While the underlying aetiology of heart failure among adults in high-income countries (HIC) is IHD, in SSA the leading causes are hypertensive heart disease, cardiomyopathy, rheumatic heart disease, and congenital heart diseases. Of concern is the tendency of CVDs to occur at younger ages in SSA populations, approximately two decades earlier compared to HIC. Obstacles hampering primary and secondary prevention of CVDs in SSA include insufficient health care systems and infrastructure, scarcity of cardiac professionals, skewed budget allocation and disproportionate prioritization away from NCDs, high cost of cardiac treatments and interventions coupled with rarity of health insurance systems. This review gives an overview of the descriptive epidemiology of CVDs in SSA, while contrasting with the HIC and highlighting impediments to their management and making recommendations. Highlights:-The burden of non-communicable diseases including cardiovascular diseases is rising in SSA.-Levels of hypertension diagnosis, treatment, and control are low at <40%, <35%, and 10-20%, respectively, and more than 40% of patients with diabetes are not aware of their diagnosis in SSA. -SSA has 23% of the world's prevalent rheumatic heart disease cases.-The leading causes of heart failure in SSA are hypertensive heart disease, cardiomyopathy, and rheumatic heart disease, with ischemic heart disease accounting for <10% of cases compared to >50% in high-income countries.

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Section: Peripheral Artery Diseasementioning

confidence: 99%

Cardiovascular Diseases in Sub-Saharan Africa Compared to High-Income Countries: An Epidemiological Perspective

et al. 2020

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“…Peripheral arterial disease (PAD) increases cardiovascular morbidity and mortality in 3% to 10% of the global population . It is associated with an increased hypertensive response and decreased calf muscle oxygenation during calf muscle flexion exercise .…”

Section: Introductionmentioning

confidence: 99%

Peripheral arterial disease: Scoping review of patient‐centred outcomes

Bolton

2019

International Wound Journal

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Peripheral arterial disease (PAD) impairs patients' quality of life (QOL), walking and ulcer healing, increasing patient pain, costs, and risks of amputation or mortality. A literature appraisal described PAD treatment capacity to improve validated patient-centred outcomes in controlled clinical studies. The PUBMED database was searched from 1 January 1970 to 21 June 2018, for original and derivative controlled clinical trial references addressing MeSH terms for 'ischemia' AND 'leg ulcer'. Non-ischemic ulcer treatment references were excluded. Frequencies of improved (P < .05) outcomes were reported. Eighty-eight studies on 4153 patients were summarized. Walking, pain or QOL improved mainly for interventions administered before PAD became severe. Amputation incidence, pain and ulcer healing were more frequently reported in those with severe PAD. Independent of PAD severity, patients experienced more likely improved walking, QOL, or pain reduction in response to structured walking interventions or those increasing calf muscle activity. Those with more severe PAD were more likely to report amputation reduction, mainly in response to invasive interventions. Those with PAD experienced more consistently improved patient-centred outcomes if they received multidisciplinary PAD management with supervised walking or calf muscle activity, with more likely amputation risk reduced for those with more severe PAD. Key Messages• Peripheral arterial disease (PAD) progresses in severity from impaired walking and quality of life (QOL) through increasing likelihood of pain, ulceration, gangrene, amputation, or death and magnifies clinical, economic, and patient burdens of venous insufficiency or diabetes • improving PAD-related patient-centred outcomes requires consistent early, effective PAD diagnosis and effective treatment to improve lower limb perfusionAbbreviations: ABI, ankle-to-brachial systolic blood pressure index (ratio), optimally performed using handheld Doppler ultrasound; ALU, arterial leg ulcers; CLI, critical limb ischaemia; DAPT, dual antiplatelet therapy, for example, aspirin plus low molecular weight heparin; DFU, diabetic foot ulcers; ER, endovascular revascularisation; HBO, hyperbaric oxygen; IC, intermittent claudication; IPC, intermittent pneumatic compression of the calf muscle; MLU, mixed aetiology leg ulcers complicated with peripheral arterial disease; NMES, neuromuscular electrical stimulation sufficient to cause contraction of the calf muscle; PAD, peripheral arterial disease; PPG, photoplethysmography a technique for measuring venous emptying; QOL, quality of life; RCT, randomised clinical trial; SET, structured exercise therapy supervised by a professional; SOC, standard of care; TcPO 2 , transcutaneous partial pressure of oxygen; VLU, venous leg ulcer.

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“…There is a dearth of study in general population on PAD using ABI from West Africa. Johnston et al in their review noted that African's PAD prevalence ranged from 3.1% to 24% of adults aged 50 years and older and 39% to 52% of individuals with known risk factors (eg, diabetes) [5]. In their systematic door-to-door survey, Guerchet et al reported prevalence of 15% and 32.4% in general population over the age of 65 years in Bangui (Central African Republic) and Brazzaville (Congo) [13].…”

Section: Discussionmentioning

confidence: 99%

“…The minimum sample size was estimated to 753 by using Schwartz formula n=1,962 p(1-p)/i2 where p=4% was the reported prevalence of PAD in general population [5] and i=1% was the error risk. The recruitment was systematic for all workers, aged 18 and over, who signed the consent sheet.…”

Section: Study Design Setting and Samplingmentioning

confidence: 99%