Peripheral artery disease (PAD) is on the rise, especially in Asia where it is increasing faster than in other regions.
In 2010, 202 million people worldwide suffered from PAD.
Between then and 2015, the frequency of the condition increased by 17% globally.
However, in Asia, it rose by nearly 20%, with over 70% of the world’s new PAD cases occurring in the Asia-Pacific region since then.
One of the main reasons for this is likely the relatively low awareness of the disease.
PAD typically affects the arteries in the legs, resulting in reduced blood flow to the limbs. It may lead to disability, amputation or death.
The most common cause of PAD is the build-up of fatty deposits that cause the narrowing of arteries.
According to Hospital Canselor Tuanku Muhriz managing director and consultant vascular surgeon Professor Datuk Dr Hanafiah Harunarashid, aside from ageing, unhealthy lifestyle habits such as smoking, lack of exercise and a high intake of foods with saturated fat, are among the key risk factors for PAD.
Diabetics are especially at risk for PAD with around one in six (16%) diabetes patients in Malaysia suffering from this condition.
He says: “PAD not only disrupts patients’ quality of life, but also has greater consequences such as limb amputation.
“It is not uncommon for patients with PAD to need to undergo a lower limb amputation, with or without previous revascularization attempts.”
He also notes that the impact of the amputation and disease goes far beyond physical disability and financial burden for treatment.
“Clinical reports have indicated that a significant number of lower limb amputees are experiencing psychological adjustment problems.
“The quality of life of a person is likely to be adversely affected following an amputation of his/her body parts.
“It is reported that 47.4% of amputees have depressive symptoms, while 24.5% of these patients were diagnosed to have major depression.
“He/she may find it challenging to adjust to new limitations as the normal physical activities this individual used to perform are now curtailed,” he says.
Hospital Putrajaya consultant endocrinologist and Malaysian Endocrine and Metabolic Society president Dr Zanariah Hussein stresses the importance of early prevention for PAD to ensure that it doesn’t lead to major amputation.
She says: “There is an urgent need to address the unmet needs and disease burden for patients suffering from PAD.
“Not many are aware that the main factor of PAD – the narrowing or blockage of the arterial supply to the foot – can be prevented, and globally, the success of amputation reduction has reached 50% to 75%.
“Early diagnosis is advisable and this can be easily done with basic clinical examination by general practitioners (GPs) or nurses.”
Says Prof Hanafiah: “The good news is that breakthrough in medication has resulted in viable treatment that can help lessen the burdens brought by PAD.
“The end goal in treating patients with PAD is to maintain healthy blood flow in the peripheral arteries.
“This will subsequently help to prevent serious events such as loss of limb that may lead to disability, which in turn decreases a person’s quality of life.”
Antiplatelet therapy, such as aspirin, is the recommended treatment for PAD.
However, the Health Ministry recently approved the use of the anti-coagulant medication Xarelto, to be taken along with low dose aspirin, for the prevention of major adverse events in the limbs, e.g. amputation, in PAD patients.
Also known by its generic name rivaroxaban, Xarelto helps to prevent blood clots by inhibiting Factor Xa, an enzyme that acts at a key point in the blood-clotting process.
Two clinical trials, Voyager PAD and Compass, showed that Xarelto, along with aspirin, benefits PAD patients who have undergone revascularization, in the prevention of further serious complications like inadequate blood supply to the limbs, amputation, heart attack, stroke and death.
Universiti Malaya Specialist Centre senior consultant cardiologist and National Heart Association of Malaysia president Prof Dr Wan Azman Wan Ahmad notes that, “On top of available treatments for PAD, patients are advised to adopt a healthy lifestyle and consult their healthcare practitioners for proper screening and diagnosis for prevention and early detection.”
Maintaining their medication schedule is also important to prevent other complications.
Says Bayer’s Pharmaceuticals Division for Malaysia, Singapore and Brunei country division head Dr Vincent Ruland: “PAD remains a major public health concern and can have devastating effects on patients physically, emotionally and economically.
“At Bayer, our goal is to consistently leverage on the latest in medicinal technology for a solution that caters to the current unmet needs in PAD management.”
Prof Hanafiah, Dr Zanariah, Prof Wan Azman and Dr Ruland were speaking at the launch of the new indication for Xarelto in Kuala Lumpur on Sept 3 (2020).
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