AHA Scientific Statement Addresses Disparities in Incidence and Treatment of PAD

June 19, 2023—The American Heart Association (AHA) recently announced in a new AHA scientific statement that low-cost, routine testing may help to reduce disparities and health care costs for people with peripheral artery disease (PAD).

“Health Disparities in Peripheral Artery Disease” reviews the latest research, outlines racial and ethnic disparities in PAD diagnosis and treatment, and offers potential solutions to reduce disparities and increase health equity among people with PAD. The scientific statement was published by Matthew A. Allison, MD, et al online in Circulation.

Multiple social, economic, and health variables contribute to disparities by sex, race, and ethnicity in the development, diagnosis, and treatment of PAD.

The AHA press release outlined some of the disparities identified in the statement as follows:

• Approximately one in three Black adults may develop PAD, compared to approximately one in five Hispanic or White adults.
• When seeking medical care, Black adults are more likely to have more advanced PAD and are more likely to undergo leg or foot amputation in comparison to peers who are White adults.
• Compared to White adults, Black, Hispanic, and American Indian adults experience lower survival rates and worse quality of life after amputation. People in these demographic groups are also less likely to use a prosthesis to regain the ability to walk and more likely to live in a nursing home.
• People from underrepresented racial and ethnic groups also have an increased risk of death after amputation, with the rate of death within 5 years ranging from 45% to 60%, depending on the location of the amputation.
• Limited access to health care resources may play a role in differences in outcomes for patients with PAD. Underrepresented, rural, and low-income adults are at greater risk of being uninsured and are more likely to seek care at a more advanced stage of the disease compared with White, urban, and higher-income adults, which increases the risk for amputation.

The AHA noted that the statement advises routine, low-cost preventive screening and monitoring for people with PAD that includes hemoglobin A1c testing, ankle-brachial index measurements, and, for those with type 2 diabetes, foot exams to check for ulcerations and neuropathy.

There are also disparities in risk factors for PAD, where smoking is the most important risk factor. The statement says that people who are of American Indian and Alaska Native descent have higher rates of smoking than people from other racial and ethnic groups. Although smoking rates have decreased in the United States overall, the decline has been lower among Black and American Indian adults.

Other risk factors for PAD include type 2 diabetes, high blood pressure, high cholesterol, and obesity. People who are Black or Hispanic have higher rates of obesity compared with White adults in the United States. In addition, Black adults with PAD have higher rates of type 2 diabetes, high blood pressure, and chronic obstructive pulmonary disease than White adults.

Differences in vascular health may also contribute to higher rates of PAD among Black adults.

The statement suggested opportunities to reduce disparities in PAD care from three perspectives: a system-wide approach that integrates PAD screening into routine care, improving cultural competence and increasing diversity of clinicians and physicians, and improving community education and support programs

Additional key takeaways from the statement include:

• Quitting smoking, improving diet, and exercise therapy are critical to reducing cardiovascular risk, mortality, and amputation rates in people with PAD.
• Interventions that increase access to healthy foods and ensure sensitivity to diverse cultural eating patterns may help reduce hospital admissions and health care costs. Examples include programs that partner with food banks and implement community gardens.
• For people with established PAD, medications to manage blood pressure, lower cholesterol, and reduce blood clotting may be considered to reduce the risk of heart attack, stroke, amputation, and cardiovascular death.
• Surgical revascularization procedures that restore blood flow in blocked arteries, such as lower extremity arterial bypass, were found to be less likely to be offered in certain regions of the United States, especially among Black, Hispanic, and American Indian populations. Greater access to these procedures and follow-up care may also help reduce disparities.

Finally, the press release noted that the AHA and 25 other organizations have developed the PAD National Action Plan to increase public awareness and understanding of PAD, prevent complications, address health barriers, and improve quality of life for people living with the condition.