Higher peripheral artery disease prevalence, worse outcomes persist among Black adults
Key takeaways:
- Nearly one in three Black adults will develop peripheral artery disease.
- Black adults are more likely to develop advanced PAD and undergo foot and leg amputations than Hispanic or white adults.
Black adults are significantly more likely to develop peripheral artery disease than Hispanic or white adults even when accounting for traditional risk factors, and often present with advanced disease tied to worse outcomes like amputation.
In a new scientific statement from the American Heart Association, researchers noted that approximately one in three Black adults develop PAD over their lifetime compared with one in five Hispanic or white adults, whereas quality of life and survival rates are worse for people from underrepresented groups. The authors wrote that a “confluence of social, economic and health variables” contributes to the disproportionate prevalence of PAD among Black adults, and a holistic view of PAD is necessary to craft the appropriate tiered strategic measures.
“There are significant disparities in the way we care for patients with PAD and addressing social determinants of health is priority in patients with PAD,” Carlos I. Mena-Hurtado, MD, associate professor of medicine (cardiology), director of vascular medicine and co-director of the Vascular Medicine Outcomes Program (VAMOS) at Yale New Haven Hospital and Yale University, told Healio. “More resources should be allocated at the regional, local and national level to care for this underserved population.”
Differences in disease presentation
Given comparable PAD severity and comorbidities, Black patients with PAD present with a disproportionately increased risk for amputation across socioeconomic strata compared with other groups, according to the statement.
“Beyond access to care/resources and health care professional bias, other explanations for racial differences in disease distribution include the disproportionate representation of diabetes, kidney disease, metabolic syndrome and inflammation,” the researchers wrote. “Black patients present with more advanced critical limb ischemia/critical limb-threatening ischemia (CLI/CLTI), including gangrene or foot sepsis, compared with white patients with CLI/CLTI who tend to present with ulcers or rest pain.”
Black patients also tend to have increased arterial stiffness, small vessel disease and more severe infrapopliteal disease.
“Even while adjusting for PAD severity and comorbidities, Black patients with CLI/CLTI are less likely to undergo limb salvage revascularization and instead are more likely to undergo major lower-extremity amputation compared with white patients,” the researchers wrote.
Lifestyle behaviors such as diet, obesity and smoking contribute to PAD risk and are important in its treatment, the researchers wrote.
Although few Americans have diets that are consistent with healthful patterns, the differences in income, education and food access among different racial and ethnic groups make healthy eating and weight management more challenging.
Role of social determinants
Social determinants of health are linked to the development of PAD, the statement notes. Prevalence studies show higher rates of PAD with lower income, lower education levels and less social support, with higher risk for amputation with lower socioeconomic status.
“Current frameworks link structural health elements, including economic status, built environment, education access, health care access, food quality and community resilience to chronic stressors and downstream adverse physiological effects, including chronic inflammation,” the researchers wrote. “Racial discrimination is also associated with elevated biomarkers of systemic inflammation and vasoconstrictor responses in Black American men related to higher sympathetic nerve activity, potentially reflecting influence of chronic stress.”
The statement notes that physician-patient race concordance, cultural competency training and community education models can help improve PAD outcomes.
“It is essential that health care professionals understand the disparities in PAD prevalence and outcomes in order to provide appropriate, evidence-based care and bridge the gaps in the treatment of this diverse patient population,” Mena-Hurtado said in a press release. “Health care systems need to optimize cost-effective interventions at every step.”
Reference:
- Nearly 1 in 3 Black adults may develop PAD; disparities in care increase amputation risk. Available at: https://newsroom.heart.org/news/nearly-1-in-3-black-adults-may-develop-pad-disparities-in-care-increase-amputation-risk. Accessed: June 15, 2023.
For more information:
Carlos I. Mena-Hurtado, MD, can be reached at carlos.mena-hurtado@yale.edu; Twitter: @carlosmenayale.
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