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Case Report | DOI: https://doi.org/10.31579/2641-0419/394
Introduction: Patients hospitalised in cardiology departments often have multiple cardiovascular conditions related to atherosclerosis. Peripheral artery disease (PAD), often diagnosed late, is one of the main manifestations of this. The objectives of this study were to determine the hospital frequency of PAD in a cardiology department and to analyse the factors associated with abnormalities in the ankle-brachial index (ABI).
Methodology: This was a cross-sectional, descriptive, and analytical study conducted over a 5-month period from 15 February to 15 July 2023. We included patients admitted to the cardiology department during this period who had at least one cahigh prevalence of cardiovascular risk factors. It was generally asymptomatic, justifying the widespread screening using ABI.
*Corresponding Author: Aliou Alassane Ngaide (Associate Professor), University Cheikh Anta Diop of Dakar, Faculty of Medicine / Cardiology Department, Dalal Jamm Hospital, Guédiawaye, Senegal.
Citation: Aliou Alassane Ngaide, Joseph Salvador Mingou, Ngone Diaba Gaye, et.al, (2024), Screening for Peripheral Artery Disease by Measuring the Ankle-Brachial Index in Patients Hospitalised in a Cardiology Department in Dakar, Senegal, J Clinical Cardiology and Cardiovascular Interventions, 7(8); DOI: 10.31579/2641-0419/394
Copyright: © 2024, Aliou Alassane Ngaide. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 15 July 2024 | Accepted: 25 July 2024 | Published: 05 August 2024
Keywords: peripheral artery disease; ankle-brachial index; cardiology; senegal
University Cheikh Anta Diop of Dakar, Faculty of Medicine / Cardiology Department, Dalal Jamm Hospital, Guédiawaye, Senegal.
Atherosclerosis is by far the leading human arterial disease today. Affecting large and medium-sized arteries, it is defined as an obstructive disease of the vessels in the lower limbs [1, 2]. It consists of an atheromatous obstruction of arteries located between the abdominal aorta and the digital arteries supplying the lower limbs. Peripheral artery disease is often asymptomatic, underdiagnosed, under-recognised, and undertreated. It is associated with significant cardiovascular and cerebrovascular morbidity and mortality [3]. After coronary and cerebral involvement, peripheral artery disease (PAD) is, by frequency, the third most common location of atherosclerosis [4]. It is estimated that over 200 million individuals worldwide are affected by lower extremity artery disease. This prevalence is thought to have increased by approximately 25
Our study included 450 patients, with a male predominance (sex ratio 1.08). The mean age was 58 years +/- 13. The age group of 60 to 69 years was the most represented (27.3%) (Figure 1). The majority of patients came from the suburbs of Dakar, accounting for 78%. Socioeconomic status was considered low in more than half of the patients (65.4%) (Figure 2). The main cardiovascular risk factors found were sedentary lifestyle (98%), hypertension (60.7%), menopause (43.3%), diabetes (27.3%), and smoking (20.7%) (Figure 3). Additionally, 40% of patients had at least 4 cumulative cardiovascular risk factors (Figure 4). In this study, patients with very high cardiovascular risk were 2.2 times more likely to develop PAD.
Figure 1: Distribution of patients according to age group (n=450)
Figure 2: Distribution of patients according to socio-economic status (n = 450)
Figure 3: Distribution according to cardiovascular risk factors (n=450)
Figure 4: Evaluation of cumulative cardiovascular factors (n=450)
| Risk Factors | OR | 95% CI | p value |
| Advanced age 60 years | 1.9 | [1.1 – 3.3] | 0.02 |
| Obesity | 2.0 | [1.1 – 3.5] | 0.018 |
| Very high cardiovascularrisk | 2.2 | [1.2 – 4.1] | 0.012 |
| Erectile dysfunction | 2.5 | [1.4 – 4.5] | 0.002 |
| Intermittent claudication | 1.8 | [1.0 – 3.2] | 0.04 |
Table I: Cardiovascular Risk Factors Associated with the Onset of PAD
Clinically, 24.2% of patients had intermittent claudication, 12.9% had rest pain, and 1.3% had foot ulcers. Intermittent claudication increased the risk of PAD by 1.8 times. Erectile dysfunction, evaluated using the IIEF score, was observed in 30.7% of male patients, mostly mild (16.7%) or severe (8.9%). Erectile dysfunction was associated with a 2.5 times increased risk of developing PAD (p-value=0.002). Physical examination revealed lower limb edema in 30% of patients, mostly bilateral and related to heart failure. Palpation of anterior and posterior tibial pulses was weakly palpable or absent, with rates ranging from 26.7% to 40% for weakly palpable pulses and from 0.7% to 3.3% for absent pulses. Patients showing signs of PAD were classified into subgroups according to the Leriche and Fontaine Classification, with 16.55
This study presents several limitations that should be considered when interpreting the results. One significant limitation was the relatively low number of included patients due to non-receptivity and cooperation issues among some interviewed patients. Additionally, many patients lacked information about their condition, with a substantial portion being unaware of their treatment plans.
Furthermore, being a monocentric study conducted in a public hospital located in the suburbs of the capital city, the study parameters may not
fully represent broader demographic and socioeconomic groups. The hospital primarily serves patients from low to middle-income backgrounds. Moreover, the high cost of biological and radiological tests may have restricted access to comprehensive diagnostics for some participants. As a result, the study findings may not be generalizable to patients from higher socioeconomic backgrounds due to differences in psychosocial factors and living standards. These difficulties could have affected the quality of the collected data and consequently, the study conclusions. It would be pertinent to consider these limitations when interpreting the results and propose improvements for future studies.
Our study, conducted on 450 patients in the suburbs of Dakar, provides epidemiological and clinical insights into cardiovascular diseases that can be compared with recent studies in the literature. The male predominance (sex ratio of 1.08) and a mean age of 58 years are consistent with other studies such as those conducted by Kannel and Criqui, which also found a male predominance and similar age averages among patients with cardiovascular diseases. The most represented age group in our study was 60-69 years (27.3%), suggesting an increased prevalence of cardiovascular diseases among older individuals. Peripheral arterial disease (PAD) of the lower limbs is prevalent in individuals aged 50 and older. While population-based studies suggest a higher prevalence of asymptomatic disease and more severe, multi-visceral disease at the time of diagnosis among women, there is a lack of studies that have specifically examined sex differences in the diagnosis of PAD [9, 10, 11].
However, our study highlights a low socioeconomic status in 65.4% of patients, which is an important risk factor that could be targeted for public health interventions, as it is rarely addressed in studies from high- income countries. Economic factors appear to have a significant effect on PAD epidemiology. In the same country, low socioeconomic status is associated with PAD, both in the United States, Europe, and Africa [2, 12]. The major cardiovascular risk factors identified, such as hypertension (60.7%), menopause (43.3%), diabetes (27.3%), and smoking (20.7%), were comparable to those observed in other regions of Africa [2]. It is notable that 40% of patients had at least four cardiovascular risk factors, which accentuates their vulnerability. All studies agree that smoking is probably the most powerful contributor to PAD [8, 13]. According to a longitudinal study of men working in the United States, the attributable share of smoking to the presence of PAD in this population was estimated at 44% [14]. Diabetes is a powerful and independent factor in the occurrence of PAD [15, 16]. The risk of PAD is generally multiplied by 2 to 4, and this risk increases with the duration of diabetes. In its asymptomatic form, the study of the association between diabetes and a low ABI is made difficult by the potential presence of medial calcification, which could decrease the sensitivity of ABI in detecting PAD [17]. Diabetes being a less prevalent risk factor in the general population, its attributable share in the occurrence of PAD in the population is 14% [14]. Regarding hypertension, most studies agree that it is an independent risk factor for PAD, although the strength of the association is weaker, with an odds ratio ranging from 1.5 to 2 [8, 13].
The clinical manifestations of our population, such as intermittent claudication (24.2%) and rest pain (12.9%), as well as foot ulcers (1.3%), indicate advanced manifestations of PAD in these patients. However, according to the study of Bauersachs, Only 5%-10% of patients with PAD present with classical symptoms of intermittent claudication [18]. Other studies conducted in Europe and the United States, which used questionnaires, define the prevalence of intermittent claudication as less than 1
This study highlights the high prevalence of peripheral artery disease (PAD) within a cardiology setting. PAD is a common manifestation of atherosclerosis and is associated with the usual risk factors of atheromatous diseases. It is a chronic condition with a typically long subclinical period, and clinical expression often occurs after the age of 60. This underscores the need for multidimensional management that considers socio-economic factors, lifestyle habits, and associated comorbidities. Prevention and treatment of PAD should be integrated into a comprehensive approach to cardiovascular risk reduction.
While our study findings are consistent with global and regional cardiovascular disease trends, future research should involve larger, multicentre samples to better understand and address the specific needs of diverse populations.
Ethics approval and consent to participate: This study was approved by the ethics committee of Cheikh Anta Diop University of Dakar. All patients included in the study signed a written informed consent. For patients who were in shock, the consent was signed by a trusted person
Not Applicable
The data and materials of this study are available upon request and ready to be shared. For further information, please contact the corresponding author, Aliou Alassane NGAIDE.
None of the other authors have any conflicts of interest or relevant disclosures.
The study did not receive any funding.
Aliou Alassane NGAIDE and Abdoul KANE designed the study protocol, participated in the data collection and writing of the draft manuscript.
Joseph Salvador MINGOU participated in statistical analysis and interpretation of results.
Ngone Diaba GAYE and Caroline Andreas MEKA oversaw the execution of the study, participated in data analysis and critically revised the manuscript for important intellectual content.
Marguerite Tening DIOUF and Aime Mbaye SY participated in study design and in data analysis.
Sincere thanks to Professor Abdoul Kane for his unwavering support, his foresight, and his exemplary management.
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