RIPHERAL ARTERIAL DISEASE

Peripheral arterial disease (PAD) is a circulatory problem in which nar- rowed arteries reduce blood flow to the limbs and causes
symptoms of leg pain with walking (claudication). PAD is defined as ankle brachial index (ABI) lower than or equal to 0.90.
Globally, the burden of PAD is increasing. In 2010, there were more than 200 million people living with PAD, 69.7% of them in
LMICs, including 54.8 million in South- east Asia and 45.9 million in the western Pacific Region 26 (Fig. 2–15). The burden of
PAD has steadily increased over time, but the rate of change is higher in LMICs (the number of individuals with PAD between
2000 and 2010 increased by 28.7% in LMICs and 13.1% in high-income countries).

The age distribution varies by region. In developed countries, among adults aged 45 to 49 years, the prevalence is similar for
males and females and is around 5%. The prevalence increase to around 18% for males and females in those aged 85 to 89
years.26 In developing

countries, the same age groups, the prevalence is around 6% for females and 3% for males and increases to 15% in females and
14% in males.26 In high-income regions, notably Europe and North America, the larg- est age group with PAD was more than 55
years of age, compared to western Pacific and Southeast Asia regions where the majority of cases were in people younger than 55
years.26

Smoking is an important risk factor with and odds ratio for current smoking of 2.72 [95% CI, 2.39-3.09 (CI, confidence interval)]
in high- income countries and 1.42 (95% CI, 1.25-1.62) in LMICs, followed by diabetes, hypertension, and
hypercholesterolemia.26

Disability and mortality associated with PAD has increased over the past 20 years, and this increase in burden has been greater
among women than among men. The largest relative change in median death rate was in the Asia-Pacific–high income region and
was largely driven by higher death rates in women: +17.36 (95% CI, 1.79-32.01) versus +1.25 (95% CI, 0.13-2.39) in men. The
median DALYs for PAD was larger in developing nations than in developed nations (1.15; 95% CI, 0.80-1.66 in developing vs
0.77; 95% CI, 0.55-1.08 in developed).27

The burden of PAD is no longer confined to the elderly population but now involves young adults. Similar to IHD, there is an
increas- ing burden of PAD in developing regions and exceeds the increases in developed areas. 27 Multifaceted approaches that
address the risk factors, such as avoiding smoking initiation and promoting smoking cessation, promoting exercise and healthful
diet, as well as improve- ments in the diagnosis, treatment, and prevention of this disease are all urgently needed in order to
reduce the burden of PAD globally.26

ATRIAL FIBRILLATION
Atrial fibrillation (AF) and atrial flutter are irregular heart rhythms that often cause a rapid heart rate and can increase the risk of
stroke, heart failure, and other heart-related complications. During AF, the atria beat chaotically and out of “sync” with the
ventricles. Symptoms include heart palpitations, shortness of breath, and weakness. Overall, there is a lower estimated AF
prevalence rate and death rate in lower- income countries 28,29 (Fig. 2–16). It is unclear whether the significantly