• Posted June 16, 2023

Black Patients Face Greater Risks From Leg Artery Blockages

A new study has unearthed significant racial disparities in both treatment and outcomes for peripheral artery disease (PAD).

Black patients with this condition, where plaque builds up in the arteries of the legs, were more likely to have a stroke, heart attack or amputation than white patients, according to researchers from Keck Medicine at the University of Southern California in Los Angeles.

Black patients were also 50% less likely than white patients to get vascular interventions that could make a big difference in outcomes.

“We discovered that Black patients are nearly 50% less likely to receive vascular interventions to potentially restore the blood flow than white patients, and consequently are at a disproportionately higher risk of a stroke, heart attack or amputation,” said study author Dr. David Armstrong, a podiatric surgeon specializing in limb preservation with Keck Medicine.

“Additionally, Black patients tend to have more advanced PAD and are sicker at the time of diagnosis, indicating they may not be getting as timely medical attention as their white counterparts,” he added in a university news release.

PAD affects about 8 to 12 million Americans. It's associated with nearly half of 150,000 amputations in the United States each year.

While symptoms usually begin with something mild, such as leg cramps or muscle pain, once it is detected through a blood test the condition is typically treated with medication and lifestyle changes.

The next step can be to have a procedure known as revascularization, which improves blood flow to the arteries with a balloon or stent to open them or reroutes the blood to a healthier artery.

Black patients were more likely to only receive medication and lifestyle change recommendations, the researchers found.

“Our findings suggest Black patients are missing out on potentially limb- and lifesaving treatments,” Armstrong said. “And because Black patients tend to be sicker at the time of diagnosis than white patients, they may actually be in more need of a revascularization than other patients.”

Data for the study came from a national database. The researchers compared rates of diagnostic testing, treatment patterns and outcomes after diagnosis of PAD among commercially insured patients for the years 2016 to 2021. The team considered demographics, markers of disease severity, health care costs, patterns of medical management and rates of amputation and cardiovascular events.

About 455,000 of the patients in the study were white and 96,000 were Black.

The findings were published recently in the journal Advances in Therapy.

Reasons for disparities could include that Black patients are already at a higher risk of developing PAD, Armstrong said. Inequities may also be due to unconscious bias or barriers to health care for certain populations.

“We hope this study will encourage physicians to take these differences into account when diagnosing and treating PAD, to ensure that vascular interventions are being equally provided to all patients,” he said. “We also urge health professionals to offer more routine screenings for PAD in Black patients.”

More information

The U.S. National Institutes of Health has more on peripheral artery disease.

SOURCE: University of Southern California, news release, June 13, 2023