Peripheral Arterial Disease Among Patients With Chronic Obstructive Pulmonary Disease Attending the Chest Clinic at Kenyatta National Hospital

Abstract

Background. Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Cardiovascular disease (CVD) has been shown to be the leading causes of death among COPD patients, with many dying from ischaemic heart disease. Peripheral arterial disease (PAD) is an atherosclerotic process that is characterized by an increased risk of coronary and cerebrovascular ischemic events. PAD has been shown to occur with greater frequency among COPD patients compared to the general population. There is no data looking at the burden of cardiovascular disease among COPD patients in Kenya. We carried out the study to determine the prevalence of PAD and the prevalence of some associated cardiovascular risk factors among COPD patients at Kenyatta National Hospital (KNH) Chest clinic. Objective of the study. To determine the prevalence of PAD and selected associated cardiovascular risk factors (diabetes, hypertension, hyperlipidaemia, obesity, cigarette smoking, hsCRP and age) among COPD patients at the Kenyatta National Hospital Chest clinic. Methods. Patients with a spirometry diagnosis of COPD attending the chest clinic in KNH were consecutively recruited until the minimum desired sample size of 78 patients was achieved. They underwent spirometry to confirm the diagnosis of COPD as per the GOLD criteria where a post bronchodilator FEV1/FVC <70 % is diagnostic for COPD. A targeted history and physical examination was done and an Ankle-brachial index (ABI) was measured using a hand-held Doppler device. Finally, blood samples were drawn to analyse for fasting lipid profile, fasting blood sugar and high-sensitivity C- Reactive Protein (hsCRP). Results. Between 1st October 2016- 31st January 2017., a total of 80 COPD patients were enrolled in the study. More than a half of the patients were above the age of 65 years (58.8%. n=47). The mean age was 65.6 (11.4) years. Majority of the patients studied were males (67.5%) and thirty-five (43.8%) resided in rural areas. Only 3.8% of the patients had attained a tertiary level of education and 46.3% of the study patients were self-employed.

The overall prevalence of PAD was 7.5%. Hyperlipidaemia was the most common cardiovascular risk factor at 47.5%, followed by hypertension at 46.3% and diabetes at 8.8%. Twenty-one percent of the patients were obese, and 96.3% of the patients had a hsCRP level that was >3mg/l. Only two patients had symptomatic PAD. Conclusion. The study demonstrated a low prevalence of PAD and a high prevalence of PAD-associated cardiovascular risk factors among our COPD patients. Of the patients who had PAD, only two were found to be symptomatic.