Peripheral Artery Disease in African Americans: Prevalence, Review of Disease Disparities and Causes of These Disparities: Why Do African Americans Have a Higher Prevalence of PAD and Why is the Disease More Severe?
Peripheral artery disease (PAD) is more prevalent in African Americans (AA) than in the White population.
For the first time, we publish estimates of the number of AA in the U.S. with PAD. To the best of our knowledge there are no other estimates of PAD prevalence in the AA population. Based on the Diabetes Method, the AA prevalence of PAD includes numbers for the 2020-2040 period for total PAD, as well as by disease severity; intermittent claudication (IC), critical limb ischemia (CLI) and asymptomatic/atypical (AS/AT) disease.
Not only are there racial differences in PAD prevalence and severity, but there are significant differences in treatments and treatment outcomes.
The causes for these disparities are multifactorial. Numerous factors contribute to the higher prevalence of PAD, greater disease severity and poorer treatment outcomes in AA. These include differences in risk factors and comorbidities, higher prevalence of risk factors, the greater impact of multiple risk factors, lower socioeconomic status, geography, female gender, lower disease awareness, discrimination and genetics.
Based on the current published data, we have identified several relatively ignored factors that we believe contribute significantly to racial disparities in PAD/CLI. These are female gender, microvascular disease, chronic kidney disease, socioeconomic factors and genetic variants. With the exception of socioeconomic status, these have not been the focus of much research or discussion.
Conclusions regarding disparities are as follows: African American PAD/CLI disparities are gender disparities, PAD/CLI disparities are socioeconomic disparities, microvascular disease (retinopathy, neuropathy and nephropathy) plays a key role in these racial differences and PAD/CLI differences reflect racial variants in genetic factors. Finally, chronic kidney disease is a common factor in gender, microvascular disease and genetic disparities.
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