Time trends in peripheral artery disease incidence, prevalence and secondary preventive therapy: a cohort study in The Health Improvement Network in the UK

Abstract

ObjectivesTo assess time trends in symptomatic peripheral artery disease (PAD) incidence and prevalence, and secondary preventive therapy.DesignCohort study using The Health Improvement Network.SettingUK primary care.ParticipantsIndividuals aged 50–89 years identified annually between 2000 and 2014. Participants with symptomatic PAD were identified using Read codes.Outcome measuresIncidence and prevalence of symptomatic PAD from 2000 to 2014, overall and by sex and age. Proportion of patients prescribed secondary preventive therapy with acetylsalicylic acid (ASA), clopidogrel, an ACE inhibitor, an angiotensin receptor blocker (ARB) and/or a statin.ResultsThe incidence of symptomatic PAD per 10 000 person-years decreased over time, from 38.6 (men: 51.0; women: 28.7) in 2000 to 17.3 (men: 23.1; women: 12.4) in 2014. The prevalence of symptomatic PAD decreased from 3.4% (men: 4.5%; women: 2.5%) in 2000 to 2.4% (men: 3.1%; women: 1.7%) in 2014. Incidence and prevalence decreases were observed in all age groups. The proportions of patients prescribed ASA monotherapy, clopidogrel monotherapy and dual antiplatelet therapy in the 2 months after PAD diagnosis were 42.7%, 2.9% and 2.5%, respectively, during 2000–2003, and 44.7%, 11.0% and 5.2%, respectively, during 2012–2014. For ACE inhibitor/ARB therapy and statins, proportions in the 2 months after diagnosis were 30.2% and 31.2%, respectively, during 2000–2003, and 45.1% and 65.9%, respectively, during 2012–2014.ConclusionThe incidence and prevalence of symptomatic PAD diagnosed in UK primary care are decreasing. A large proportion of the population with PAD in clinical practice does not receive guideline-recommended secondary prevention therapy.

Time trends in the risk of atrial fibrillation and ischaemic stroke in patients with peripheral artery disease between 1997 and 2015

“…[18][19][20] Indeed, patients with PAD are at remarkably high risk of cardiovascular and cerebrovascular diseases, which are concomitantly present in more than half of the patients with PAD. 21 It is commonly known that AF is strongly correlated to atherosclerotic vascular disease. 22 As PAD is one of the cardinal signs representing the presence of systemic atherosclerosis, AF and PAD often coexist.…”

Epidemiology of major lower limb amputation using routinely collected electronic health data in the UK: a systematic review protocol

“…5 In the UK the prevalence of symptomatic PAD is decreasing with figures of 2.4% in 2014 compared with 3.4% in 2000. 6 Open access This is surprising given the significant increase in diabetes, one of the major risk factors. 7 Other key risk factors for PAD include: smoking, age, hypertension and dyslipidaemia.…”

Positive and negative well-being of older adults with symptomatic peripheral artery disease: A population-based investigation

“…As such, the present findings may not directly generalise beyond the study sample. Moreover, although our baseline data were collected in 2005, we consider them to be still clinically relevant because 1) the specific PAD and well-being measures we employed continue to be valid and widely used in population studies; 28 2) the prevalence of PAD in the older adult UK population has declined only slightly over the past two decades; 44 3) a significant proportion of older adults living with PAD fail to receive guideline-recommended care and well-being support, 44 and; 4) the relevant evidence based remains poor given that few investigations similar to the present one have been undertaken since 2005. Third, it is possible that additional characteristics, not considered in the present study (e.g.…”