Report on the epidemiology of PAD, TAO and CLI in India

Nov 13 2009

A new analysis published by THE SAGE GROUP concludes that atherosclerotic peripheral arterial disease (PAD) afflicts over 20 million in India. Both PAD and CLI represent major and significantly underestimated problems for the Indian economy and healthcare system.

“Although it is commonly believed that PAD is a ‘Western’ disease with a lower prevalence in Asian Indians, our research indicates that this is not the case,” stated Mary L. Yost, author of the report. “PAD appears to afflict Indians at similar rates as those found in European and U.S. populations in the same age and risk factor groups,” she continued.

“The key factor is age,” Yost explained. “Older age is known as one of the most significant risk factors for both PAD and CLI. India has a much younger population with an average age of 23 whereas the average age in the U.S. is 35 and in Germany 40.”

PAD is also known as peripheral vascular disease (PVD) or peripheral arterial occlusive disease (PAOD). It is characterized by a reduction of blood flow to the lower limbs due to atherosclerosis.

In critical limb ischemia blood flow is so inadequate that ulcerations and gangrene occur. Once PAD has progressed to CLI, the risks of limb loss and mortality increase. At six months approximately 20% of those with CLI will die; another 40% will experience amputation.

“CLI represents ‘end-stage’ Peripheral Arterial Disease,” explained Ms. Yost.

According to Yost, “Research on the epidemiology of critical limb ischemia remains sparse. There appears to be little or no population-based data on the number of people suffering from PAD and/or CLI in India.”

“Our estimates of the number of people suffering from PAD and CLI in India are based on the ‘Diabetes Method,’ which we previously employed in Western Europe and the United States,” Ms. Yost continued. “In the absence of large-scale, population-based studies, we believe that the Diabetes Method provides the most accurate assessment of lower limb disease prevalence,” Yost declared.

“The Diabetes Method begins with segmenting the population by age and glucose status, calculating the prevalence of peripheral arterial disease (PAD) in each glucose category and finally the prevalence of critical ischemia by PAD and glucose status,” explained Ms. Yost.

With 41 million diabetics, India has become known as the ‘Diabetic Capital of the World.’

“Because diabetics represent 60% to 80% of CLI patients, we believe that India may unfortunately be on the path to becoming the Critical Limb Ischemia Capital,” Ms. Yost concluded.

Critical limb ischemia can also be caused by Buerger’s Disease (thromboangiitis obliterans or TAO) a non-atherosclerotic, occlusive inflammatory disease that most commonly affects the small and medium sized arteries, veins and nerves in the upper and lower extremities. Approximately 40% of patients who continue to smoke will require an amputation.

According to Yost, “Compared with PAD, Buerger’s Disease is relatively uncommon in India. We estimate that fewer than 400,000 cases of critical limb ischemia are caused by Buerger’s Disease.”

The report titled ‘India: Peripheral Arterial Disease, Thromboangiitis Obliterans and Critical Limb Ischemia Epidemiology and Markets’ is the third in a series published on CLI. The first report focused on CLI epidemiology in the United States; the second focused on CLI in the 15 major countries of Western Europe.

The India report analyzes the epidemiology of PAD, TAO and CLI in India including the prevalence of major risk factors; tobacco use, hypertension, dyslipidemia and diabetes in the Indian population. The number of people with PAD, TAO and CLI is projected for the 2008-2015 periods. Market analysis includes the number of patients and limbs diagnosed and treated for each disease category. An overview of Indian demographics as well as the economic and healthcare system is also provided.

Source THE SAGE GROUP