Peripheral Artery Disease and African Americans: Review of the Literature

Abstract

Peripheral artery disease (PAD) is a chronic, obstructive disease of the peripheral vasculature which is a coronary heart disease risk equivalent. African Americans (AA) are at the highest risk for developing this disease at every age group. The purpose of this review is to shed light on the risk factors for PAD and their implications for disease manifestation in AA, and to highlight ways to combat these known racial disparities in order to achieve cardiovascular health equity in this population. Even after controlling for differences in the prevalence of known cardiovascular risk factors, AA are still significantly more likely to have PAD. In part, due to a disproportionate amount of cardiovascular risk factors and detrimental socioeconomic factors, AA with PAD have a worse prognosis and more unfavorable outcomes than other ethnic groups with PAD. AA with PAD are more likely to have limb loss with amputation and less likely to receive revascularization leading to limb salvage. Advanced age, cigarette smoking, diabetes, hypertension, hyperlipidemia, chronic kidney disease, and poor socioeconomic status or education level have all been associated with increased risk of PAD. AA have a higher likelihood of having many, but not all, of these conditions. Nevertheless, increased cardiovascular risk for PAD combined with a relative lack of awareness about the disease in the AA community leads to poor health outcomes. Targeted interventions that partner healthcare access and delivery in community-based, non-traditional health care settings as well as the traditional clinics and hospitals may prove to be a more successful means of outreach in this high-risk population.