Prevalence of peripheral arterial disease in Nepal: A cross-sectional study

Abstract

Background

Peripheral arterial disease (PAD) represents a significant cardiovascular burden in low- and middle-income countries (LMICs), yet its prevalence in Nepal remains unknown. As Nepal undergoes demographic transition with increasing life expectancy and cardiovascular disease burden, understanding PAD prevalence is crucial for healthcare planning. We aimed to determine PAD prevalence among Nepali adults aged ≥45 years using ankle-brachial index (ABI) screening.

Methods

This cross-sectional study was conducted at two sites in Nepal between October 2022 and March 2023. Participants aged ≥45 years without a prior PAD diagnosis were recruited through voluntary screening during routine care visits. We collected demographic data, cardiovascular risk factors, and claudication symptoms. PAD was defined as ABI <0.9, with ABI >1.4 considered non-diagnostic due to incompressible vessels.

Results

Among 639 participants (median age 60 years, IQR 53-68; 52% male), 638 were included in the analysis. The overall PAD prevalence was 7.4% (95% CI 5.6%-9.7%), increasing to 8.7% (95% CI 6.6%-11.3%) when excluding incompressible ABIs (14.9% of participants). PAD prevalence increased with age, reaching 12.1% in those >75 years. Participants with PAD showed significantly higher rates of cardiac disease (15% vs 4%, p = .002) and claudication symptoms (26% vs 10%, p = .001) compared to those with normal ABIs. Diabetes was more prevalent in those with incompressible ABIs compared to normal ABIs (26% vs 15%, p = .02).

Conclusions

This first systematic assessment of PAD in Nepal reveals a prevalence comparable to other South Asian countries, with significant associations with cardiac disease and claudication symptoms. The findings highlight the need for enhanced vascular disease education in Nepal, where only 25 vascular surgeons serve 31 million people. Future research should include expanded geographic sampling and longitudinal outcomes to inform national screening policies and resource allocation.