Peripheral artery disease (PAD) affects millions of individuals worldwide, and recent research has revealed concerning disparities in its prevalence and outcomes, particularly among different racial and ethnic groups. A scientific statement from the American Heart Association underscores the need for holistic care, consideration of social determinants of health, and the promotion of health equity to address these disparities effectively.
Alarming Prevalence Disparities
According to the scientific statement, approximately one in three Black adults develop PAD over their lifetime, compared to one in five Hispanic or white adults. Even when accounting for traditional risk factors, such as diabetes and kidney disease, Black adults remain significantly more likely to develop PAD. Additionally, they often present with advanced disease, which is associated with worse outcomes like amputation.
The authors of the statement attribute the disproportionate prevalence of PAD among Black adults to a confluence of social, economic, and health variables. A comprehensive understanding of PAD and the factors contributing to its prevalence is crucial to devise effective, tiered strategic measures.
Disease Presentation and Worse Outcomes
Among patients with comparable PAD severity and comorbidities, Black patients are at a higher risk of amputation, regardless of socioeconomic status. Black patients with PAD tend to present with more advanced critical limb ischemia/critical limb-threatening ischemia (CLI/CLTI), such as gangrene or foot sepsis, whereas white patients with CLI/CLTI typically present with ulcers or rest pain.
Furthermore, Black patients often exhibit increased arterial stiffness, small vessel disease, and more severe infrapopliteal disease. Even after adjusting for PAD severity and comorbidities, Black patients with CLI/CLTI are less likely to undergo limb salvage revascularization and more likely to undergo major lower-extremity amputation compared to white patients.
Social Determinants of Health
The scientific statement highlights the significant role of social determinants of health in the development of PAD. Studies indicate higher rates of PAD in individuals with lower income, education levels, and less social support. Moreover, lower socioeconomic status is associated with a higher risk of amputation.
The link between social determinants of health and PAD development is multifaceted. Factors such as economic status, built environment, education access, healthcare access, food quality, and community resilience influence chronic stress levels and subsequent adverse physiological effects, including chronic inflammation. Racial discrimination is also associated with elevated biomarkers of systemic inflammation and vasoconstrictor responses, indicating the influence of chronic stress on Black Americans.
Promoting Health Equity and Improving Outcomes
To address disparities in PAD prevalence and outcomes, the scientific statement suggests several key strategies. Physician-patient race concordance, cultural competency training, and community education models can help improve PAD outcomes. It is crucial for healthcare professionals to understand the
