Peripheral arterial disease - high prevalence in rural black South Africans

The prevalence of peripheral arterial disease (PAD) worldwide has been estimated at between 4.5% and 29%. PAD has been associated with male gender, advanced age, diabetes, hypertension, hypercholesterolaemia and smoking. Clinical experience with amputations at Mthatha General Hospital, a district hospital in the Eastern Cape, suggests that PAD is common, but the actual prevalence has not been determined. The Eastern Cape is a rural area and patients attending the hospital are mostly Xhosa-speakers.

To assess the prevalence of PAD and associated risk factors among patients attending the hospital.

Five hundred and forty-two patients over 50 years of age attending the outpatient department were systematically selected. Gender, body mass index (BMI), blood pressure, capillary blood glucose and smoking status were determined. The ankle-brachial pressure index (ABPI) was measured by Doppler ultrasound, and PAD was defined as a ratio less than 0.9.

Of 542 patients (315 females, 227 males), 159 (29.3%) had an ABPI of less than 0.9. The mean age was 62.4 years and the range 50 - 95 years. In a stepwise logistical regression analysis smoking had a significant adjusted odds ratio for PAD of 4.29 (2.68 - 6.95), diabetes 1.72 (1.11 - 2.69) and male sex 1.69 (1.06 - 2.68). Obesity as measured by BMI and hypertension were not associated with PAD.

Prevalence of PAD was relatively high in this sample of rural black patients when compared with findings from other countries. Preventive interventions should focus on control of diabetes and smoking cessation. Surprisingly, the prevalence was higher in those with a normal BMI and without hypertension, and risk factors in this community should be studied further. Physicians in this setting should be more aware of the possibility of undetected PAD.