Changing pattern of Peripheral Vascular disease in Asian countries

of tobacco use, there is no other definitive therapy 2 . Selective cannabinoid receptor antagonists have shown promise for helping patients to stop smoking. Prostacycline analogues may help patients with critical limb ischaemia. Recent innovative genetic and cell-based therapeutic approaches have been proposed to induce angiogenesis but they require evaluation in randomized controlled trials to confirm their

may be due to acute or chronic atrial fibrillation, valvular heart disease, or recent myocardial infarction, whereas a history of intermittent claudication, and rest pain suggests thrombosis of existing PVD 6 .
The early symptomatic PVD might manifest in the form of intermittent claudication.The level of ing vascular occlusion is determined by the intermittent pain and it's manifestations like: aortoiliac disease presenting as pain in the thigh and buttock, whereas femoral-popliteal disease causing pain in the calf.Pain is precipitated by walking a predictable distance (Claudication distance) and is relieved by rest.In chronic disease, collateral circulation may develop; reducing the symptoms of intermittent claudication, but failure to control precipitant factors and risk factors often causes its reemergence.At times the misleading factors might exist in PVD causing intermittent pain in the hip or leg "giving out" after a certain period of exertion and may not demonstrate the typical symptom of pain on exertion.It is unusual to experience pain while sitting or standing, if the limb is not critically ischaemic 7  ease in Asia have come from the same institution.These have included an experience with 533 patients undergoing abdominal aortic aneurysm surgery between 1975 and 1995, again demonstrating a rising annual incidence of a peripheral vascular disorder in Hong Kong. 10The risk factors observed in these studies was similar to that seen in western populations, with male dominance (1.6:1), smoking (59%), hypertension (55%) and diabetes mellitus (42%).Lipid abnormalities were also documented and they included hypercholesterolemia (55%) and elevated low-density lipoprotein (60%) and triglyceride (31%) levels. 3Atherosclerotic occlusive disease predominantly affected the femoropopliteal segment (49%).In a similar interval (1978-1996)  only 89 confirmed cases of Buerger's disease were seen 11 .
Changing trends in the Asian countries is similar as in the western countries.A multicenter cross-sectional study was carried out at eight centers in all the provinces of Pakistan on people with type2 Diabetes mellitus.The study demonstrates a high prevalence of PVD among people with type 2 diabetes in Pakistan which needs to be appropriately evaluated by the medical professionals 12 .Perhaps the most disturbing aspect of the changing epidemiology, with profound implications for health resource planning, is the escalating prevalence of type 2 diabetes mellitus: a level of 300 million diabetic individuals is projected worldwide by 2025, almost half of whom will be in the Asia-Pacific region.An Indian study concluded that the population of India is steadily aging and the prevalence of diabetes is rising sharply.PVD as one of the complication of diabetes will emerge as a very significant cause of morbidity and mortality in India 13 .
That this will result in a need for additional vascular surgical expertise and facilities seems inevitable.Among non-communicable diseases, cardio-vascular diseases (CVD) are an important public health problem.Although no accurate data is yet available, the burden of CVDs is expected to be high in view of behavioral and lifestyle changes in developing countries like Pakistan, India, china, Hong Kong and other countries.The prevalence of peripheral vascular disease (PVD) is rising in line with an ageing population.There is a strong association with concomitant coronary artery and cerebral vascular disease in these patients, which represents a significant cause of mortality and morbidity in patients with PVD 14 .Disease affecting the lower extremity peripheral vessels is most aggressive in smokers and diabetics and more worse if two are more factors are contributing simultaneously 15 .Moreover, many primary care physicians and the majority of citizens do not possess adequate knowledge concerning the prevention and management of cardio-vascular diseases 16 .We foresee the major disease burden in Asian countries in next two decades and accordingly all stakeholders must plan and adopt appropriate proactive strategies for prevention and management of peripheral vascular disease in the region 17 .The academic institutions must re-appropriate their human and material resources aiming to effective preventive and curative measures for PVD and we should establish more vascular units in our hospitals to get by the emerging situations.

The author is a consultant vascular surgeon and Dean/ Principal of AJK Medical College Muzaffarabad (Pakistan)
Changing pattern of Peripheral Vascular disease in Asian countries