Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi.
Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
BMJ Open. 2022 Aug 10;12(8):e055501. doi: 10.1136/bmjopen-2021-055501.
Low/middle-income countries face a disproportionate burden of cardiovascular diseases. However, among cardiovascular diseases, burden of and associations with lower extremity disease (LED) (peripheral arterial disease and/or neuropathy) is neglected. We investigated the prevalence and factors associated with LED among individuals known to have cardiovascular disease risk factors (CVDRFs) in Malawi, a low-income country with a significant prevalence of CVDRFs.
This was a stratified cross-sectional study.
This study was conducted in urban Lilongwe Area 25, and the rural Karonga Health and Demographic Surveillance Site.
Participants were at least 18 years old and had been identified to have two or more known CVDRFs.
LED-determined by the presence of one of the following: neuropathy (as assessed by a 10 g monofilament), arterial disease (absent peripheral pulses, claudication as assessed by the Edinburgh claudication questionnaire or Ankle Brachial Pulse Index (ABPI) <0.9), previous amputation or ulceration of the lower limbs.
There were 806 individuals enrolled into the study. Mean age was 52.5 years; 53.5% of participants were men (n=431) and 56.7% (n=457) were from the rural site. Nearly a quarter (24.1%; 95% CI: 21.2 to 27.2) of the participants had at least one symptom or sign of LED. 12.8% had neuropathy, 6.7% had absent pulses, 10.0% had claudication, 1.9% had ABPI <0.9, 0.9% had an amputation and 1.1% had lower limb ulcers. LED had statistically significant association with increasing age, urban residence and use of indoor fires.
This study demonstrated that a quarter of individuals with two or more CVDRFs have evidence of LED and 2.4% have an amputation or signs of limb threatening ulceration or amputation. Further epidemiological and health systems research is warranted to prevent LED and limb loss.
中低收入国家面临着不成比例的心血管疾病负担。然而，在心血管疾病中，下肢疾病（外周动脉疾病和/或神经病）的负担及其与心血管疾病风险因素（CVDRFs）的关联被忽视。我们在马拉维（一个 CVDRFs 患病率很高的低收入国家）调查了已知患有心血管疾病风险因素（CVDRFs）的个体中下肢疾病（LED）的患病率及其相关因素。
这是一项分层的横断面研究。
本研究在城市利隆圭区 25 号和农村卡隆加健康和人口监测点进行。
参与者年龄至少 18 岁，并被确定患有两种或两种以上已知的 CVDRFs。
LED 通过以下一种情况确定：神经病（通过 10 g 单丝评估）、动脉疾病（周围脉搏缺失、爱丁堡跛行问卷评估的跛行或踝肱脉搏指数（ABPI）<0.9）、下肢截肢或溃疡。
共有 806 人参加了这项研究。平均年龄为 52.5 岁；53.5%的参与者为男性（n=431），56.7%（n=457）来自农村地区。近四分之一（24.1%；95%CI：21.2%至 27.2%）的参与者至少有一个 LED 的症状或体征。12.8%有神经病，6.7%有脉搏缺失，10.0%有跛行，1.9%有 ABPI<0.9，0.9%有截肢，1.1%有下肢溃疡。LED 与年龄增长、城市居住和使用室内火灾呈统计学显著关联。
本研究表明，四分之一患有两种或两种以上 CVDRFs 的个体有 LED 证据，2.4%有截肢或肢体威胁性溃疡或截肢的迹象。需要进一步进行流行病学和卫生系统研究，以预防 LED 和肢体丧失。
