Dr Arvind Kohli
Today August 6 is the National Vascular Disease Awareness Day. Malady strikes around 42 million patients every year of which over six millions result in death. At a time when the public is being increasingly informed about disorders like Ebola and West Nile Virus it seems imperative to know about more common and potentially life threatening vascular disorders in India.
Vascular diseases, including atherosclerotic peripheral vascular diseases causing leg attacks aortic aneurysms, venous thromboembolism and carotid diseases causing stroke are prevalent in India and the incidence of these diseases is on rapid increase .When unrecognized or inadequately treated, these disorders may be life threatening and disabling. The therapeutic landscape for these conditions is on the cusp of evolution with new therapies and devices in development; yet health professional and patient awareness is low. To lower the mortality and morbidity associated with these is a challenge for both healthcare providers and patients .
Future of Vascular Diseases
Significant accomplishments have been made in the treatment of peripheral vascular disorders. There have been major advances in the science of vascular biology leading to novel insights into the pathogenesis of atherosclerosis and thrombosis, the role of endothelial function in health and disease, and the identification of targets for new therapies. The biology of aortic aneurysms is being explored, and potential new treatments for aortic disease are emerging. Endovascular interventions are doing wonders in management of aortic aneurysms. Discovery science has yielded novel classes of oral anticoagulant drugs for treating venous thromboembolism. Further on the management of Carotid plaques have also undergone a sea change with the advent of new devices.
Patient and Caregiver Education
PAD epitomizes a cardiovascular condition in which there are a variety of treatment options that variably impact outcomes (death, limb loss, claudication, physical activity and quality of life). Different patients would be expected to derive different benefits and risks from treatment. While evidence-based guidelines provide directions for an ideal treatment, they cannot take into account each individual’s unique demographic, co-morbidity and disease severity characteristics. To improve the consistency of care and to enable patients to be more engaged in shared medical decision-making, guideline based care must be individualized e.g smoking cessation, exercise, medication use and adherence, peripheral and surgical revascularization) can be generated.
Similarly, awareness of venous thromboembolism (VTE) is woefully low; less than one in 10 Indians knows about deep vein thrombosis and is familiar with its symptoms or risk factors. The awareness and prevention of venous thromboembolic disease also needs a significant surge for the health care providers since it’s a disabling condition and can lead to serious complications like pulmonary embolism which is virtually fatal. Although it is feasible to prevent VTE using known prophylactic measures, such measures are unlikely to be used in a “VTE unaware” public.
Screening programs for detection of Aortic aneurysms are very important as Abdominal aortic aneurysm (AAA) causes over 15,000 preventable deaths but there is limited public awareness data. While AAA is associated with fear of death, few individuals know that a history of a first order relative with an AAA, or that male tobacco exposure, defines a cohort in whom AAA screening is known to be effective.
Stroke, like many conditions affecting the vascular system, can do detrimental damage to not just your blood vessels, but to the entire body, if left unmonitored or uncontrolled. The effects of a stroke directly affect the brain, which, as the control center of the brain, can ultimately affect other systems in the body, resulting in a loss in motor skills, speech, balance, or memory. Not only this, but of the 42 million strokes that occur each year, over 6 million will result in death. Stroke is caused by plaque blockage in either one or both of the carotid arteries, the vascular connection leading to the brain. Blood flows through the aorta (the largest artery in the body) to the carotid arteries, one on either side of the neck. Due to a number of risk factors, plaque can begin to buildup in the arteries, causing them to narrow andstiffen. Often irregular and misshaped, these plaque deposits can collect in the narrowed areas. When this happens, decrease in blood flow and oxygen supply to the brain occurs, causing a stroke.
However, if caught early, stroke doesn’t have to have a place in a vascular lifestyle – the best way to assure this is to know the best methods of stroke prevention, diagnosis, and risk factors for the carotid artery disease that can lead to stroke.
Public Awareness : Most important effort which is required is to generate public awareness which is leveraged to prevent, diagnose, and treat individuals at risk for, or who suffer from, cardiovascular disease (CVD). Our public and health professional vascular disease awareness efforts are not aligned with the epidemiology. There are no effective vascular public awareness efforts underway. It is true for most vascular diseases that “What you don’t know can kill you.” At a time when the public is actively informed about Ebola, or West Nile Virus, it would seem appropriate for the public to be informed about more common and potentially 1ife-threatening vascular disorders.
Early diagnosis and Treatment
Diagnosis of PAD can be improved by ensuring increased utilization of accepted diagnostic algorithms in hospital and emergency care settings. Provider awareness is essential also for timely diagnosis of diseases like pulmonary embolism, the symptoms of which are often misdiagnosed as myocardial ischemia, asthma or chronic obstructive pulmonary disease.
Physician education and dissemination of treatment guidelines, including risk factor modification such as smoking cessation, lowering high cholesterol, treating diabetes, as well as institution of antiplatelet therapy, will reduce the risk of adverse cardiovascular outcomes in patients with Vascular diseases. Also, physicians should know when to refer patients with severe claudication or critical limb ischemia of AAA or significant carotid stenosis to a vascular specialist for further management.
Vascular Day emphasis the need on part of health care providers, physicians vascular specialists to spread awareness about preventing vascular diseases. Prevention of vascular disease begins by providing clear, accurate information, at an appropriate reading level in various educational formats. It must also be culturally and linguistically tailored.The key to prevention is increased public and healthcare provider awareness of the risk factors such as obesity, diabetes, smoking and lack of physical activity. The public would benefit from understanding the symptoms of each disease and the long-term consequences of foregoing treatment. Equally important is the role of the public, society and policy makers for achieving these goals.
(The author is Consultant, Govt. Super Speciality Hospital, Jammu)
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