By Matey Juric, Roger S. Blumenthal, and Martha Gulati
Underuse of medication to improve cholesterol, blood pressure, and blood sugar for peripheral artery disease (PAD) has been reported in several studies. However, Latino and Hispanic populations have often been under-represented in these studies, so researchers examined data from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) to better understand the usage of medication for PAD within this population.
Researchers concluded that even among Hispanic/Latino population, the use of cardiovascular medication in individuals with PAD is considerably below what is recommended by clinical guidelines.
Peripheral artery disease is a common circulatory problem where narrowing of the arteries reduces blood flow to the limbs. Often with PAD, the legs do not receive enough blood flow, which leads to pain within the lower extremities with walking or other types of exercise.
In this study published in the Journal of the American Heart Association, 1,244 participants between the ages of 18 and 74 were chosen from four locations: New York City (Bronx), Chicago, Miami, and San Diego. Each participant was of either Dominican, Cuban, Central American, Mexican, Puerto Rican, or South American background. Of those, 826 participants had previously been diagnosed with PAD by a physician. The remaining 418 participants had only coronary artery disease (CAD), and they were used as a measure of internal comparison among the HCHS/SOL cohort.
Researchers studied the prevalence in the use of antiplatelet therapy (such as aspirin), lipid-lowering therapy, and hypertensive therapy between the two groups by asking them to bring in any medication they had taken in the past four weeks. Among those diagnosed with PAD, researchers looked at several factors that could be associated with the differences in the usage of medications such as accessibility to health care, and socioeconomic and demographic factors.
Of those diagnosed with PAD, 60% had more than two cardiovascular risk factors (for example obesity, diabetes, high blood pressure) and 70% had a household income of less than $30,000. Medication usage of the participants for antiplatelet therapy and lipid-lowering therapy was 31% and 26%, respectively. Usage varied among different Latino/Hispanic groups, with participants of Mexican backgrounds having the lowest use of cardiovascular medication. Groups where the majority of individuals had health insurance coverage (Puerto Ricans) used antiplatelet and statin medication more frequently when compared to groups with lower rates of health insurance.
With the availability of medications that have beneficial effects, the underuse of them among the Latino/Hispanic community is alarming. Amputation, which is often due to a prolonged period of leaving PAD untreated, is two times greater in Latinos/Hispanics compared to non-Hispanic whites. Thus, it is imperative to raise awareness among physicians about the treatment of patients with PAD according to the guidelines, the authors write.
Although the study does provide important information about a population that is generally understudied, there are limitations. This study was conducted during one period in a single year; therefore, without data across several years, it is hard to estimate the true prevalence of medication usage among this population. Also, the participants of the study were chosen from four cities across the United States, preventing generalization of these findings to the Hispanic/Latino community elsewhere in the country.
While prolonged research is needed to definitively determine how prevalent the underuse of medications is among the Latino/Hispanic community, more effort should be directed toward helping this population receive improved preventive treatment, the authors conclude.
It is important for patients and their clinicians to remember the ABCs Of Prevention and discuss whether they apply to an individual patient:
A: Aspirin and other blood thinner
B: Blood Pressure goal is < 130/80
C: Cigarette/Tobacco avoidance
C: Cholesterol: If PAD, the goal bad LDL-cholesterol is < 70 mg/dl and the goal triglyceride level is < 150
D: Dietary/weight improvements
E: Exercise: Aim for a minimum of 30 minutes of moderate to brisk activity daily
To learn more about peripheral artery disease, visit CardioSmart.org/PAD.
Matey Juric is a premedical student at Drexel University. Roger S. Blumenthal, MD, FACC, is Director of the Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease. Martha Gulati, MD, FACC, is the Editor-in-Chief of CardioSmart.