Peripheral Arterial Disease Prevalence in a Population-Based Sample of People with Diabetes on the Caribbean Island of Barbados
O Peter Adams,1 Joseph R Herbert,1 Nigel Unwin,2– 4 Christina Howitt2 1Faculty of Medical Sciences, University of the West Indies, Cave Hill Campus, St Michael, Barbados; 2George Alleyne Chronic Disease Research Centre, University of the West Indies, St. Michael, Barbados; 3MRC Epidemiology Unit, Un...
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| Format: | Article |
| Language: | English |
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Dove Medical Press
2022-05-01
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| Series: | Vascular Health and Risk Management |
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| Online Access: | https://www.dovepress.com/peripheral-arterial-disease-prevalence-in-a-population-based-sample-of-peer-reviewed-fulltext-article-VHRM |
| _version_ | 1811233490198331392 |
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| author | Adams OP Herbert JR Unwin N Howitt C |
| author_facet | Adams OP Herbert JR Unwin N Howitt C |
| author_sort | Adams OP |
| collection | DOAJ |
| description | O Peter Adams,1 Joseph R Herbert,1 Nigel Unwin,2– 4 Christina Howitt2 1Faculty of Medical Sciences, University of the West Indies, Cave Hill Campus, St Michael, Barbados; 2George Alleyne Chronic Disease Research Centre, University of the West Indies, St. Michael, Barbados; 3MRC Epidemiology Unit, University of Cambridge, Cambridge, UK; 4European Centre for Environment and Human Health, University of Exeter, Truro, UKCorrespondence: O Peter Adams, Faculty of Medical Sciences, University of the West Indies, Cave Hill Campus, St. Michael, Barbados, Tel +1 246 417 4260, Fax +1 246 438 9170, Email peter.adams@cavehill.uwi.eduBackground: Peripheral arterial disease (PAD) is a risk factor for amputation and systemic atherosclerotic disease. Barbados has a high diabetes prevalence, and 89% of diabetes-related hospital admissions are for foot problems. Foot examination is infrequent in Barbados primary care. The prevalence and potential risk factors for PAD in people with diabetes in Barbados were studied.Methods: Multistage probability sampling was used to select a representative population sample of people ≥ 25 years of age with known diabetes or fasting blood glucose ≥ 7 mmol/L or HbA1c ≥ 6.5%. We administered the Edinburgh claudication questionnaire and assessed the ankle brachial pressure index (ABI) and Doppler waveform in both dorsalis pedis and posterior tibial arteries. Participants were classified into categories based on ABI as follows: PAD ≤ 0.90 in any leg; borderline 0.91 to 0.99 in one leg and the other not ≤ 0.90 or > 0.4; normal 1.00 to 1.40 in both legs; and non-compressible > 1.40 in one leg and the other not ≤ 0.9. Waveforms crossing the zero-flow baseline were categorised as normal. Multivariable logistic regression assessed the associations of potential risk factors with PAD.Results: Of 236 participants (74% response rate, 33% male, median age 58.6 years), 51% had previously diagnosed diabetes. Of nine people with symptoms of definite or atypical claudication, four had PAD and one had non-compressible arteries. ABI prevalence (95% CI) was PAD 18.6% (13.8, 24.6), borderline 21.9% (16.6, 28.4), normal 55.5% (49.4, 61.5) and non-compressible 3.9% (1.6, 9.3). Increasing age and female gender were independently associated with PAD. Over 80% of normal legs (ABI 1.00 to 1.40) had normal posterior tibial and dorsalis pedis waveforms, while only 23% legs with PAD (ABI ≤ 0.90) had normal waveforms in both arteries (Kappa = 0.43).Conclusion: Asymptomatic PAD is common in people with diabetes and requires ABI screening to detect it. Female gender is associated with PAD.Keywords: diabetes, peripheral arterial disease, peripheral artery disease, claudication, waveform, Doppler ultrasound |
| first_indexed | 2024-04-12T11:20:54Z |
| format | Article |
| id | doaj.art-54e391306ff24a82b83305fcd7734ca4 |
| institution | Directory Open Access Journal |
| issn | 1178-2048 |
| language | English |
| last_indexed | 2024-04-12T11:20:54Z |
| publishDate | 2022-05-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Vascular Health and Risk Management |
| spelling | doaj.art-54e391306ff24a82b83305fcd7734ca42022-12-22T03:35:22ZengDove Medical PressVascular Health and Risk Management1178-20482022-05-01Volume 1838739575640Peripheral Arterial Disease Prevalence in a Population-Based Sample of People with Diabetes on the Caribbean Island of BarbadosAdams OPHerbert JRUnwin NHowitt CO Peter Adams,1 Joseph R Herbert,1 Nigel Unwin,2– 4 Christina Howitt2 1Faculty of Medical Sciences, University of the West Indies, Cave Hill Campus, St Michael, Barbados; 2George Alleyne Chronic Disease Research Centre, University of the West Indies, St. Michael, Barbados; 3MRC Epidemiology Unit, University of Cambridge, Cambridge, UK; 4European Centre for Environment and Human Health, University of Exeter, Truro, UKCorrespondence: O Peter Adams, Faculty of Medical Sciences, University of the West Indies, Cave Hill Campus, St. Michael, Barbados, Tel +1 246 417 4260, Fax +1 246 438 9170, Email peter.adams@cavehill.uwi.eduBackground: Peripheral arterial disease (PAD) is a risk factor for amputation and systemic atherosclerotic disease. Barbados has a high diabetes prevalence, and 89% of diabetes-related hospital admissions are for foot problems. Foot examination is infrequent in Barbados primary care. The prevalence and potential risk factors for PAD in people with diabetes in Barbados were studied.Methods: Multistage probability sampling was used to select a representative population sample of people ≥ 25 years of age with known diabetes or fasting blood glucose ≥ 7 mmol/L or HbA1c ≥ 6.5%. We administered the Edinburgh claudication questionnaire and assessed the ankle brachial pressure index (ABI) and Doppler waveform in both dorsalis pedis and posterior tibial arteries. Participants were classified into categories based on ABI as follows: PAD ≤ 0.90 in any leg; borderline 0.91 to 0.99 in one leg and the other not ≤ 0.90 or > 0.4; normal 1.00 to 1.40 in both legs; and non-compressible > 1.40 in one leg and the other not ≤ 0.9. Waveforms crossing the zero-flow baseline were categorised as normal. Multivariable logistic regression assessed the associations of potential risk factors with PAD.Results: Of 236 participants (74% response rate, 33% male, median age 58.6 years), 51% had previously diagnosed diabetes. Of nine people with symptoms of definite or atypical claudication, four had PAD and one had non-compressible arteries. ABI prevalence (95% CI) was PAD 18.6% (13.8, 24.6), borderline 21.9% (16.6, 28.4), normal 55.5% (49.4, 61.5) and non-compressible 3.9% (1.6, 9.3). Increasing age and female gender were independently associated with PAD. Over 80% of normal legs (ABI 1.00 to 1.40) had normal posterior tibial and dorsalis pedis waveforms, while only 23% legs with PAD (ABI ≤ 0.90) had normal waveforms in both arteries (Kappa = 0.43).Conclusion: Asymptomatic PAD is common in people with diabetes and requires ABI screening to detect it. Female gender is associated with PAD.Keywords: diabetes, peripheral arterial disease, peripheral artery disease, claudication, waveform, Doppler ultrasoundhttps://www.dovepress.com/peripheral-arterial-disease-prevalence-in-a-population-based-sample-of-peer-reviewed-fulltext-article-VHRMdiabetesperipheral arterial diseaseperipheral artery diseaseclaudicationwaveformdoppler ultrasound |
| spellingShingle | Adams OP Herbert JR Unwin N Howitt C Peripheral Arterial Disease Prevalence in a Population-Based Sample of People with Diabetes on the Caribbean Island of Barbados Vascular Health and Risk Management diabetes peripheral arterial disease peripheral artery disease claudication waveform doppler ultrasound |
| title | Peripheral Arterial Disease Prevalence in a Population-Based Sample of People with Diabetes on the Caribbean Island of Barbados |
| title_full | Peripheral Arterial Disease Prevalence in a Population-Based Sample of People with Diabetes on the Caribbean Island of Barbados |
| title_fullStr | Peripheral Arterial Disease Prevalence in a Population-Based Sample of People with Diabetes on the Caribbean Island of Barbados |
| title_full_unstemmed | Peripheral Arterial Disease Prevalence in a Population-Based Sample of People with Diabetes on the Caribbean Island of Barbados |
| title_short | Peripheral Arterial Disease Prevalence in a Population-Based Sample of People with Diabetes on the Caribbean Island of Barbados |
| title_sort | peripheral arterial disease prevalence in a population based sample of people with diabetes on the caribbean island of barbados |
| topic | diabetes peripheral arterial disease peripheral artery disease claudication waveform doppler ultrasound |
| url | https://www.dovepress.com/peripheral-arterial-disease-prevalence-in-a-population-based-sample-of-peer-reviewed-fulltext-article-VHRM |
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