Prevalence of lower extremity peripheral arterial disease in diabetic patients assessed by the ankle–brachial index in sub-Saharan Africa

Background/Introduction Lower extremity peripheral arterial disease (PAD) is a major clinical manifestation of atherosclerosis, affecting arteries from the distal aorta to the foot. In patients with diabetes, PAD is associated with poor prognosis, regardless of disease stage, and is considered a marker of high cardiovascular risk. Although most epidemiological data originate from high-income countries, recent studies highlight a growing burden in low- and middle-income settings. According to the 2017 European Society of Cardiology (ESC) guidelines, the ankle–brachial index (ABI) is the recommended first-line, non-invasive test for PAD screening and diagnosis. Purpose To determine the prevalence of PAD in diabetic patients using the ABI and to analyse its association with cardiovascular risk factors and clinical characteristics. Methods We conducted a cross-sectional, descriptive and analytical prospective study over 15 months (15 September 2021 to 15 October 2022) in the cardiology department of our General Hospital. One hundred diabetic patients with complete biological assessment were included. Sociodemographic characteristics, cardiovascular risk factors, clinical and paraclinical data were collected using a structured questionnaire. ABI was calculated as the ratio of ankle systolic blood pressure (anterior and posterior tibial arteries) to brachial systolic blood pressure, measured using a manual sphygmomanometer (Spengler) and a handheld Doppler (EDAN SD3 Vascular). Data were analysed using Epi Info 7 and R (version 4). Results The mean age was 60.6 years, with a predominance of women (57%). Seventeen patients (17%) had PAD defined by ABI <0.9, while 13% had medial arterial calcification (ABI >1.3). PAD was more frequent in women (52.9% of PAD cases) and in patients aged over 60 years (70.6%). Right lower limb involvement predominated (61.5%). All patients were diabetic (99% type 2), 64% were hypertensive, 27% had dyslipidaemia and 19% were smokers. A history of cardiovascular disease was present in 73%, predominantly ischaemic heart disease (59%). Intermittent claudication was reported in 18%. Left ventricular ejection fraction was severely impaired in 27% of cases. Conclusion PAD is common among diabetic patients in this Senegalese tertiary centre, with a prevalence of 17% using ABI screening. Its association with advanced age, female sex and multiple cardiovascular risk factors highlights the need for systematic ABI assessment in diabetic patients. Early detection may improve cardiovascular risk stratification and guide preventive strategies in sub-Saharan Africa.