Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas, Dallas, TX, USA.
J Vasc Surg. 2010 Apr;51(4 Suppl):27S-35S. doi: 10.1016/j.jvs.2009.08.085. Epub 2009 Nov 24.
Peripheral arterial disease (PAD) is a highly prevalent public health problem associated with major detrimental effects on quality of life and functional status, and it is also the main cause of limb amputation. More importantly, PAD has been classified as a coronary artery disease equivalent, meaning that patients with a diagnosis of PAD carry a risk for major coronary events equal to that of established coronary artery disease. PAD is also a potent predictor of stroke and death. Despite its frequent occurrence (8 to 10 million Americans are affected), little is known about the natural history of PAD in racial/ethnic minorities, particularly in Hispanics, who represent 12.5% of the United States population. Furthermore, the disease is commonly underdiagnosed and undertreated in this minority group, and outcomes are poorer in Hispanics as compared with whites. Limited access to health care, difficulties for recruitment in population-based studies, and limitations of the noninvasive screening tests are well-established barriers to determine the prevalence and natural history of PAD in Hispanics. Although the most widely used test for assessment of patients at risk for PAD is the ankle-brachial index (ABI), the test has substantial limitations in individuals with diabetes and arterial calcification, which are highly prevalent in Hispanics. The ABI should, therefore, be supplemented by the use of other noninvasive tests, such as the pulse volume recordings (PVR) and toe-brachial index. Besides the use of a combination of diagnostic techniques, the implementation of a research methodology that improves recruitment of Hispanics in population-based studies is necessary to obtain better knowledge of the epidemiology of the disease in this group. Community-based participatory research may be the most appropriate approach to study this ethnic minority because it overcomes barriers for limited access to health care and increases the possibility of overcoming distrust of research on the part of communities. Understanding the epidemiology of PAD to improve its detection and treatment among Hispanics is relevant to reduce disparities in the health status of this group, the most rapidly growing ethnic minority in the United States.
外周动脉疾病（PAD）是一种高发的公共卫生问题，它对生活质量和功能状态有重大不利影响，也是导致肢体截肢的主要原因。更重要的是，PAD 已被归类为与冠状动脉疾病等效，这意味着诊断为 PAD 的患者发生主要冠状动脉事件的风险与已确诊的冠状动脉疾病相当。PAD 也是中风和死亡的有力预测指标。尽管 PAD 发病率较高（800 万至 1000 万美国人受其影响），但人们对外周动脉疾病在少数族裔中的自然史知之甚少，尤其是在占美国人口 12.5%的西班牙裔中。此外，该疾病在这个少数族裔群体中普遍被漏诊和治疗不足，且西班牙裔的预后比白人更差。获得医疗保健的机会有限、在基于人群的研究中招募困难以及非侵入性筛查测试的局限性，这些都是确定西班牙裔人群中 PAD 患病率和自然史的既定障碍。尽管评估 PAD 风险患者最广泛使用的测试是踝肱指数（ABI），但该测试在糖尿病和动脉钙化患者中存在较大局限性，而这些情况在西班牙裔中极为普遍。因此，ABI 应该辅以使用其他非侵入性测试，如脉搏容积记录（PVR）和趾肱指数。除了使用诊断技术组合外，还需要实施一种可改善西班牙裔人群在基于人群的研究中招募的研究方法，以更好地了解该疾病在这一人群中的流行病学。基于社区的参与性研究可能是研究这一少数族裔的最合适方法，因为它克服了获得医疗保健机会有限的障碍，并增加了克服社区对研究不信任的可能性。了解 PAD 的流行病学，以改善对西班牙裔人群的检测和治疗，对于减少这一群体健康状况的差异至关重要，西班牙裔是美国增长最快的少数族裔。
