A cross-sectional study on peripheral arterial disease in a district of Sri Lanka: prevalence and associated factors

BACKGROUND Peripheral arterial disease (PAD), a slowly progressive atherosclerotic disease affecting vital organs of the body, is increasingly recognized as a health burden worldwide. Epidemiological information on peripheral arterial disease is scarce in Sri Lanka. The present study intended to estimate the prevalence and associated factors of PAD among adults aged 40-74 years in Gampaha district, Sri Lanka. METHODS A cross-sectional study was carried out to estimate the prevalence of PAD among adults aged 40-74 years in four randomly selected divisional secretariat areas in Gampaha district in 2012-2013. The sample size of 2912 adults was obtained from 104 clusters using multistage probability proportionate to size sampling. The number of individuals to be included in the 5-year age groups between 40 and 74 years was determined based on the population proportion of the respective age groups in the district. Cluster size was 28, and equal numbers of males and females were selected for each age group per cluster. PAD was defined as having an ankle-brachial pressure index ≤ 0.89. RESULTS The age-and sex-standardized prevalence of PAD, adjusted for the sensitivity of the ankle-brachial pressure index was 3.6% (95% CI 2.9-4.3%), and no significant difference was found between males (3.7%) and females (3.6%) (p = 0.08). Eighty-eight individuals were newly identified as having PAD, and a significant trend of prevalence with increasing age was observed (p < 0.001). Histories of diabetes mellitus, hypertension, dyslipidemia, coronary artery disease, cerebrovascular accident, smoking, and erectile dysfunction among males were significantly associated with PAD (p < 0.001). Only one third of those with PAD experienced claudication symptoms. CONCLUSIONS PAD was found to be a hidden disease in the Gampaha district population. Although there is minimal attention on PAD at present, the disease is likely to become a problematic public health concern in Sri Lanka, particularly with its aging population. Primary prevention measures to modify risk factors of PAD, including screening activities for early identification, should be a priority.