Time Trends in Peripheral Artery Disease Incidence, Prevalence and Secondary Preventive Therapy: a Cohort Study in The Health Improvement Network in the UK

Overview

Journal BMJ Open

Specialty General Medicine

Date 2018 Jan 24

PMID 29358428

Citations 28

Authors

Lucia Cea-Soriano

F Gerry R Fowkes

Saga Johansson

Alaster M Allum

Luis Alberto Garcia Rodriguez

Affiliations

Soon will be listed here.

Abstract

Objectives: To assess time trends in symptomatic peripheral artery disease (PAD) incidence and prevalence, and secondary preventive therapy.

Design: Cohort study using The Health Improvement Network.

Setting: UK primary care.

Participants: Individuals aged 50-89 years identified annually between 2000 and 2014. Participants with symptomatic PAD were identified using Read codes.

Outcome Measures: Incidence and prevalence of symptomatic PAD from 2000 to 2014, overall and by sex and age. Proportion of patients prescribed secondary preventive therapy with acetylsalicylic acid (ASA), clopidogrel, an ACE inhibitor, an angiotensin receptor blocker (ARB) and/or a statin.

Results: The incidence of symptomatic PAD per 10 000 person-years decreased over time, from 38.6 (men: 51.0; women: 28.7) in 2000 to 17.3 (men: 23.1; women: 12.4) in 2014. The prevalence of symptomatic PAD decreased from 3.4% (men: 4.5%; women: 2.5%) in 2000 to 2.4% (men: 3.1%; women: 1.7%) in 2014. Incidence and prevalence decreases were observed in all age groups. The proportions of patients prescribed ASA monotherapy, clopidogrel monotherapy and dual antiplatelet therapy in the 2 months after PAD diagnosis were 42.7%, 2.9% and 2.5%, respectively, during 2000-2003, and 44.7%, 11.0% and 5.2%, respectively, during 2012-2014. For ACE inhibitor/ARB therapy and statins, proportions in the 2 months after diagnosis were 30.2% and 31.2%, respectively, during 2000-2003, and 45.1% and 65.9%, respectively, during 2012-2014.

Conclusion: The incidence and prevalence of symptomatic PAD diagnosed in UK primary care are decreasing. A large proportion of the population with PAD in clinical practice does not receive guideline-recommended secondary prevention therapy.

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References

Norgren L, Hiatt W, Dormandy J, Nehler M, Harris K, Fowkes F . Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg. 2007; 45 Suppl S:S5-67. DOI: 10.1016/j.jvs.2006.12.037. View

Read J, Sanderson H, Sutton Y . A language of health in action: Read Codes, classifications and groupings. Proc AMIA Annu Fall Symp. 1996; :75-9. PMC: 2233183. View

Tendera M, Aboyans V, Bartelink M, Baumgartner I, Clement D, Collet J . ESC Guidelines on the diagnosis and treatment of peripheral artery diseases: Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries: the Task Force on the Diagnosis and.... Eur Heart J. 2011; 32(22):2851-906. DOI: 10.1093/eurheartj/ehr211. View

Lewis J, Schinnar R, Bilker W, Wang X, Strom B . Validation studies of the health improvement network (THIN) database for pharmacoepidemiology research. Pharmacoepidemiol Drug Saf. 2006; 16(4):393-401. DOI: 10.1002/pds.1335. View

Savji N, Rockman C, Skolnick A, Guo Y, Adelman M, Riles T . Association between advanced age and vascular disease in different arterial territories: a population database of over 3.6 million subjects. J Am Coll Cardiol. 2013; 61(16):1736-43. DOI: 10.1016/j.jacc.2013.01.054. View

Nichols M, Townsend N, Scarborough P, Rayner M . Cardiovascular disease in Europe 2014: epidemiological update. Eur Heart J. 2014; 35(42):2950-9. DOI: 10.1093/eurheartj/ehu299. View

Bourke A, Dattani H, Robinson M . Feasibility study and methodology to create a quality-evaluated database of primary care data. Inform Prim Care. 2004; 12(3):171-7. DOI: 10.14236/jhi.v12i3.124. View

Fowkes F, Rudan D, Rudan I, Aboyans V, Denenberg J, McDermott M . Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis. Lancet. 2013; 382(9901):1329-40. DOI: 10.1016/S0140-6736(13)61249-0. View

Moran A, Forouzanfar M, Roth G, Mensah G, Ezzati M, Flaxman A . The global burden of ischemic heart disease in 1990 and 2010: the Global Burden of Disease 2010 study. Circulation. 2014; 129(14):1493-501. PMC: 4181601. DOI: 10.1161/CIRCULATIONAHA.113.004046. View

10.

Murray C, Dellavalle R, Danaei G, Fahimi A, Flaxman D, Gabriel S . The state of US health, 1990-2010: burden of diseases, injuries, and risk factors. JAMA. 2013; 310(6):591-608. PMC: 5436627. DOI: 10.1001/jama.2013.13805. View

11.

Alzamora M, Fores R, Baena-Diez J, Pera G, Toran P, Sorribes M . The peripheral arterial disease study (PERART/ARTPER): prevalence and risk factors in the general population. BMC Public Health. 2010; 10:38. PMC: 2835682. DOI: 10.1186/1471-2458-10-38. View

12.

Patel M, Becker R, Wojdyla D, Emanuelsson H, Hiatt W, Horrow J . Cardiovascular events in acute coronary syndrome patients with peripheral arterial disease treated with ticagrelor compared with clopidogrel: Data from the PLATO Trial. Eur J Prev Cardiol. 2014; 22(6):734-42. DOI: 10.1177/2047487314533215. View

13.

Rooke T, Hirsch A, Misra S, Sidawy A, Beckman J, Findeiss L . 2011 ACCF/AHA Focused Update of the Guideline for the Management of Patients With Peripheral Artery Disease (updating the 2005 guideline): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice.... J Am Coll Cardiol. 2011; 58(19):2020-45. PMC: 4714326. DOI: 10.1016/j.jacc.2011.08.023. View

14.

Mozaffarian D, Benjamin E, Go A, Arnett D, Blaha M, Cushman M . Heart disease and stroke statistics--2015 update: a report from the American Heart Association. Circulation. 2014; 131(4):e29-322. DOI: 10.1161/CIR.0000000000000152. View

15.

Anderson J, Halperin J, Albert N, Bozkurt B, Brindis R, Curtis L . Management of patients with peripheral artery disease (compilation of 2005 and 2011 ACCF/AHA guideline recommendations): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013; 127(13):1425-43. DOI: 10.1161/CIR.0b013e31828b82aa. View

16.

Criqui M, Aboyans V . Epidemiology of peripheral artery disease. Circ Res. 2015; 116(9):1509-26. DOI: 10.1161/CIRCRESAHA.116.303849. View

17.

Pande R, Perlstein T, Beckman J, Creager M . Secondary prevention and mortality in peripheral artery disease: National Health and Nutrition Examination Study, 1999 to 2004. Circulation. 2011; 124(1):17-23. PMC: 3139992. DOI: 10.1161/CIRCULATIONAHA.110.003954. View

18.

Kroger K, Stang A, Kondratieva J, Moebus S, Beck E, Schmermund A . Prevalence of peripheral arterial disease - results of the Heinz Nixdorf recall study. Eur J Epidemiol. 2006; 21(4):279-85. DOI: 10.1007/s10654-006-0015-9. View

19.

Olin J, Sealove B . Peripheral artery disease: current insight into the disease and its diagnosis and management. Mayo Clin Proc. 2010; 85(7):678-92. PMC: 2894725. DOI: 10.4065/mcp.2010.0133. View

20.

Felix-Redondo F, Fernandez-Berges D, Grau M, Baena-Diez J, Mostaza J, Vila J . Prevalence and clinical characteristics of peripheral arterial disease in the study population Hermex. Rev Esp Cardiol (Engl Ed). 2012; 65(8):726-33. DOI: 10.1016/j.recesp.2012.03.008. View