Abstract
BackgroundPeripheral arterial disease (PAD) is a major health problem in diabetes patients in high-income countries, but the PAD burden in sub-Saharan Africa is largely undetermined. We studied the prevalence of PAD and exertional leg symptoms in diabetes (DM) patients in a tertiary hospital in Ghana.MethodsIn a case control study design, 485 DM and 330 non-diabetes participants were recruited. PAD was diagnosed as Ankle Brachial Index (ABI) < 0.9. Edinburgh Claudication Questionnaire (ECQ) was used to assess exertional leg symptoms.ResultsThe overall prevalence of classical intermittent claudication was 10.3 % and ABI-diagnosed PAD was 26.7 %, with 3.5 % of the participants having both classic intermittent claudication and ABI-diagnosed PAD. The prevalence of exertional leg symptoms were similar in diabetes patients with and without PAD. In non-diabetes participants, intermittent claudication and rest pain were higher in PAD patients than in non-PAD participants. In multivariable logistic regression, intermittent claudication [OR (95 % CI), 3.39 (1.14 – 8.1), p < 0.05] and rest pain [4.3 (1.58 – 9.67), p < 0.001] were independently associated with PAD in non-diabetes group, and rest pain [1.71 (1.13 – 2.17), p < 0.05] was associated with PAD in all participants.ConclusionsThere is high burden of PAD and exertional leg pains in DM patients in Ghana. PAD is expressed as intermittent claudication and rest pain in non-diabetes individuals.Electronic supplementary materialThe online version of this article (doi:10.1186/s12872-016-0247-x) contains supplementary material, which is available to authorized users.
Highlights
Peripheral arterial disease (PAD) is a major health problem in diabetes patients in high-income countries, but the PAD burden in sub-Saharan Africa is largely undetermined
PAD is a common manifestation of systemic atherosclerosis, with prevalence ranging from 4 % in healthy adult population to 29 % in diabetes patients screened at outpatient clinics [2]
ankle-brachial index (ABI) categorization was associated with DM status, yet no difference in the mean ABI was observed between DM and non-diabetes controls (Table 1)
Summary
DM patients were older, with higher rate of hypertension and alcohol intake than non-diabetes controls. Exertional leg symptoms were associated with DM status, with diabetes patients having higher age and gender adjusted prevalence of classical intermittent claudication Age and gender adjusted prevalence of exertional leg symptoms were similar between PAD and non-PAD participants (Fig. 2a). In non-diabetes participants, PAD patients had higher age and gender adjusted prevalence of intermittent claudication and pain at rest tahn non-PAD participants (Fig. 2b). Compared to other leg symptoms groups, patients with intermittent claudication were older, with higher proportion of females, diabetes and hypertensive patients, and had higher systolic, diastolic and mean BPs (Additional file 2: Table S2). The unadjusted model showed that PAD was associated with increase in age, BMI, mean BP, female gender, having diabetes or hypertension, alcohol intake, second-hand smoking and use of insulin. In nondiabetes participants symptoms of classic intermittent claudication and pain at rest were associated with PAD after adjustment of confounders (Table 3)
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