Atherosclerotic peripheral arterial disease in blacks--an established problem

Area of Science:

• Vascular Surgery
• Epidemiology
• Public Health

Background:

• Peripheral arterial disease (PAD) affects diverse populations, necessitating comparative studies.
• Atherosclerosis is a leading cause of PAD, but its prevalence and characteristics may vary across ethnic groups.
• Understanding ethnic disparities in PAD is crucial for equitable healthcare delivery.

Purpose of the Study:

• To compare the incidence and characteristics of chronic peripheral arterial disease (PAD) in Black, Indian, and white patients.
• To investigate ethnic differences in specific PAD manifestations, risk factors, and disease progression.
• To evaluate surgical outcomes for aorto-iliac occlusive disease across ethnic groups.

Main Methods:

• Retrospective analysis of hospital records for patients undergoing elective evaluation for chronic PAD over two years.
• Comparison of lesion types (atherosclerosis, arteritis), distribution, and associated risk factors (hypertension, smoking, diabetes) across ethnic groups.
• Assessment of disease stage at presentation and early-to-medium term outcomes of aortobifemoral bypass surgery.

Main Results:

• Atherosclerosis was the most common lesion in all groups; arteritis was more frequent in Black patients.
• Aneurysmal disease of the aorta was more prevalent in white patients, while cerebrovascular disease was less common in Black patients.
• Black patients with aorto-iliac occlusive disease presented later but had similar surgical outcomes to white and Indian patients; they also had lower rates of ischemic heart disease, cerebrovascular disease, and hypertension, and smoked less.

Conclusions:

• Atherosclerosis is a significant clinical issue in the Black population in Natal, contrary to some beliefs.
• Ethnic variations exist in PAD presentation and risk factors, with Black patients often presenting at a more advanced stage.
• Despite differences in presentation and risk factors, surgical interventions like aortobifemoral bypass show comparable efficacy across ethnic groups.