Peripheral Arterial Disease in Sub-Saharan Africa: A Review

• Published in: JAMA surgery Vol. 151; no. 6; pp. 564 - 572
• Main Authors: Johnston, Lily E, Stewart, Barclay T, Yangni-Angate, Herve, Veller, Martin, Upchurch, Gilbert R, Gyedu, Adam, Kushner, Adam L
• Format: Journal Article
• Language: English
• Published: United States American Medical Association 01.06.2016
• Subjects: Africa South of the Sahara - epidemiology; Age Factors; Health Surveys; Humans; Peripheral Arterial Disease - complications; Peripheral Arterial Disease - epidemiology; Peripheral Arterial Disease - surgery; Prevalence; Risk Factors
• ISSN: 2168-6254; 2168-6262
• DOI: 10.1001/jamasurg.2016.0446

IMPORTANCE: Peripheral arterial disease (PAD) causes significant morbidity and is an important risk factor for cardiovascular disease–related mortality. However, the burden of PAD in sub-Saharan Africa is poorly understood. OBJECTIVE: To assess epidemiological and clinical reports regarding PAD from sub-Saharan Africa such that the regional epidemiology and management of PAD could be described and recommendations offered. EVIDENCE REVIEW: A systematic search in PubMed, Medline, Embase, the Cumulative Index to Nursing and Allied Health Literature, and Google Scholar for reports pertaining to the epidemiology and/or management of PAD in sub-Saharan Africa was performed. Reports that met inclusion criteria were sorted into 3 categories: population epidemiology, clinical epidemiology, and surgical case series. Findings were extracted and described. FINDINGS: The search returned 724 records; of these, 16 reports met inclusion criteria. Peripheral arterial disease epidemiology and/or management was reported from 10 of the 48 sub-Saharan African countries. Peripheral arterial disease prevalence ranged from 3.1% to 24% of adults aged 50 years and older and 39% to 52% of individuals with known risk factors (eg, diabetes). Medical management was only described by 2 reports; both documented significant undertreatment of PAD as a cardiovascular disease risk factor. Five surgical case series reported that trauma and diabetes-related complications were the most common indications for vascular surgery. CONCLUSIONS AND RELEVANCE: The prevalence of PAD in sub-Saharan Africa may be equal to or higher than that in high-income countries, exceeding 50% in some high-risk populations. In addition to population-based studies that better define the PAD burden in sub-Saharan Africa, health systems should consider studies and action regarding risk factor mitigation, targeted screening, medical management of PAD, and defining essential vascular care.