To the Editor:
We congratulate Lovell et al (1) for their interesting survey conducted to assess the level of knowledge of peripheral arterial disease (PAD) in Canada. Along with the United States survey (2), they highlighted the poor level of awareness of the disease and the risk factors associated with this condition. We would like to confront these issues with our findings in France.
We submitted a questionnaire to 150 consecutive patients referred to our vascular laboratory for ultrasound assessment of the lower limb arteries. They either had symptoms suggestive of PAD or had several cardiovascular disease (CVD) risk factors requiring PAD screening. The questionnaire collected the reported CVD risk factors. They were also asked in an open question to quote the risk factors they consider to be important to avoid PAD and/or to limit its worsening. Although these patients were at high risk for PAD, their response rates were even more worrisome than those obtained in the Canadian population survey. Factors quoted the most were smoking (39%), high cholesterol/lipid-rich diet (27%) and alcohol abuse (23%). The response rates regarding diabetes and hypertension were appallingly low (8% and 2%, respectively). Interestingly, 13% considered standing for long periods of time to be a risk factor for PAD, and 6% also considered cold baths to be a way to limit PAD deterioration, suggesting some confusion between PAD and symptoms related to chronic venous disease. To our knowledge, there are no other reports on this possible confusion between these two vascular diseases affecting the lower limbs. We believe that this possible confusion should be systematically screened for during the patient’s education.
Another important issue not raised in either North American survey (1,2) was the subjects’ level of awareness about a risk factor according to whether they had the risk factor themselves (eg, for a smoker to identify smoking as a risk factor). Table 1 displays the response rates regarding the four main modifiable CVD risk factors. For at least the two main risk factors for PAD – smoking and diabetes – it appears that the level of awareness about the hazards related to these two factors is higher among those who are directly concerned with them. A similar analysis in both the Canadian (1) and United States (2) surveys would be interesting to focus our health education efforts on those who would benefit the most.
TABLE 1.
Risk factors for peripheral arterial disease (PaD) quoted by patients suspected of having PaD, according to their own risk factors
| Factors quoted | Patients with the risk factor, % | Patients without the risk factor, % |
|---|---|---|
| Smoking | 45* | 34 |
| Diabetes | 15* | 2 |
| High cholesterol | 29 | 25 |
| Hypertension | 3 | 0 |
P<0.05 versus those without that risk factor
REFERENCES
- 1.Lovell M, Harris K, Forbes T, et al. on behalf of the Peripheral Arterial Disease Coalition Peripheral arterial disease: Lack of awareness in Canada. Can J Cardiol. 2009;25:39–45. doi: 10.1016/s0828-282x(09)70021-2. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Hirsch AT, Murphy TP, Lovell MB, et al. Peripheral Arterial Disease Coalition Gaps in public knowledge of peripheral arterial disease: The first national PAD public awareness survey. Circulation. 2007;116:2086–94. doi: 10.1161/CIRCULATIONAHA.107.725101. [DOI] [PubMed] [Google Scholar]