Prevalence, Associated Risk Factors and Progression of Asymptomatic Peripheral Arterial Disease at Kenyatta National Hospital
Background: The prevalence of peripheral arterial disease worldwide has been estimated at between 4.5% and 29%. Peripheral arterial disease can be asymptomatic or symptomatic. It is an independent risk factor for cardiovascular morbidity and mortality and the risk burden is similar whether it is in the asymptomatic or symptomatic form. Over two-thirds of patients with peripheral arterial disease are asymptomatic and thus not identified, resulting in inadequate identification and treatment of their risk factors. Clinical experience with amputations at Kenyatta National Hospital suggests that peripheral arterial disease is common, but the actual prevalence and natural disease progression of the asymptomatic form of disease has not been determined. Objective: To determine the prevalence of asymptomatic peripheral arterial disease and progression over a one year period in patients with cardiovascular risk factors. Study design: one year, non-interventional longitudinal study Setting: Medical and surgical outpatient clinics and wards at Kenyatta National Hospital. Patients and methods: Seventy five consenting patients with asymptomatic peripheral arterial disease determined by ankle brachial index <0.9 and the presence of cardiovascular risk factors were recruited by convenience sampling. Demographic and risk profile was recorded and extent of disease ascertained at baseline based on ankle brachial index. The patients were then followed up for 1 year and disease progression evaluated based on changes in the ankle brachial index as well as development of claudication symptoms. Results: Of the 217 people screened, 78 (36%) had asymptomatic PAD affecting 113 legs. A total of 62 (83%) patients returned for the 1-year follow-up visit. On repeat ABI measurement, 8 of the 36 normal legs developed asymptomatic PAD, and 44 (46%) of the 96 legs with asymptomatic PAD at baseline had progression of disease.There was a significant change (-0.03) in mean ABI of the worse leg over the 1 year of follow-up (p=0.001) and 13 (21%) patients developed intermittent claudication at one year. Conclusion: This study showed a high prevalence of asymptomatic PAD in our population. It also showed that a significant number of patients (52%) with at least one associated cardiovascular risk factor and asymptomatic PAD at baseline, have progression of disease over 1 year, with or without development of intermittent claudication and that those developing claudication have a significant deterioration in the ABI. Progression of asymptomatic PAD was also significantly associated with having 2 or more cardiovascular risk factors (p = 0.031).
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