MOST Malaysians may not be familiar with the term Peripheral Artery Disease (PAD). It sounds complicated but in reality, it has already impacted 200 million people worldwide.
PAD is on the rise, especially in Asia, where it is increasing faster than in other regions.
While those affected by the disease and people close to them may be well aware of its implications, the general awareness is relatively low, despite its prevalence.
In 2018, 15.6 per cent (18,267) of total deaths were caused by artery failure as reported by the Department of Statistics Malaysia (DOSM), an increase of 2.3 per cent from 2017.
Fifty people in Malaysia die daily from artery-related diseases of various causes.
While non-communicable diseases (NCDs) may be perceived as the world's biggest cause of death, there are more than double those numbers highlighting artery-related deaths worldwide every year.
REDUCED FLOW
PAD typically affects the arteries in the legs, resulting in reduced blood flow to your limbs, which may lead to amputation.
Despite other factors that contribute to PAD, the most common cause is the build-up of fatty deposits that cause the narrowing of arteries. Globally, the prevalence of the disease increased by 17 per cent between 2010 and 2015.
In Asia, it rose by nearly 20 per cent. More than 70 per cent of the world's new PAD cases over that period — and in the years since — have occurred in the Asia-Pacific region. PAD may lead to disability, loss of limb or death.
A sedentary and unhealthy lifestyle increases the risk. Professor Datuk Dr Hanafiah Harunarashid, managing director and consultant vascular surgeon, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia, says smoking, lack of exercise, a diet high in saturated fat as well as age are among the key risk factors
The prevalence of PAD increases with age, he adds, and there is a higher risk among men, those who are diabetic and those who smoke.
"PAD not only disrupts patients' quality of life but also has greater consequences such as limb amputation."
If the disease is caught early, we can inhibit its progression, he explains, so we need to be proactive.
Identifying it at an early stage means we can tackle the risk factors, encourage lifestyle modification and put patients on necessary medication.
"Results are always better if treated early, so we need more awareness and screening."
SAVING THE LIMB
If amputation becomes necessary because of PAD, the individual's quality of life will be severely affected.
Dr Hanafiah says clinical reports indicate that a significant number of lower limb amputees experience psychological adjustment problems.
It has been reported that 47.4 per cent of amputees have depressive symptoms, while 24.5 per cent are diagnosed with major depression.
"The impact of amputation and the disease goes beyond physical disability and financial burden for treatment, says Dr Hanafiah.
Malaysian Endocrine and Metabolic Society (MEMS) president and consultant endocrinologist at Hospital Putrajaya, Dr Zanariah Hussein, says the importance of early prevention for PAD must be stressed to ensure it doesn't lead to major amputations.
"There is an urgent need to address the needs and disease burden of patients suffering from PAD. Early diagnosis is advisable and this can be easily done using basic clinical examinations administered by general practitioners or nurses," she says.
Dr Zanariah adds that one in five adults has diabetes in Malaysia and PAD is often more subtl
e in presentation among patients with diabetes, compared to those without.
As a result, diabetic patients with PAD may present later at a more severe stage and a greater risk of amputation. In Malaysia, the overall prevalence of PAD is 16 per cent in the diabetic population.
Dr Hanafiah speaks of a two-pronged approach in dealing with PAD — limb saving and life saving. The goal is to prevent amputation and death.
Currently, medicinal development has led to the innovation of an antithrombotic medication, which can help lessen the risk of major adverse limb events in patients with PAD.