Prevalence of Peripheral Arterial Disease Using the Ankle-Brachial Index in Indian Population: A Scoping Review

Background: Peripheral Arterial Disease (PAD) is a major manifestation of systemic atherosclerosis and is associated with a markedly increased risk of cardiovascular and cerebrovascular events. The Ankle–Brachial Index (ABI) is a simple, reliable, and non-invasive tool for the detection of PAD. However, evidence on the prevalence of ABI-based PAD in the Indian population remains fragmented and highly variable.

Aim: To systematically map and summarize existing literature on the prevalence of PAD assessed using the Ankle–Brachial Index in the Indian population.

Methods: In this scoping review, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines were followed. Comprehensive searches were carried out in PubMed, Scopus, Medline, and Google Scholar for studies published from 2010 to 2024. Studies conducted among Indians reporting PAD prevalence using ABI were included. Data items comprising study characteristics, sample size, ABI method, cutoff used, prevalence, and associated risk factors were charted using a predefined extraction framework. No critical appraisal or meta-analysis was performed.

Results: Fifty-two studies fulfilled the inclusion criteria. Most of these were hospital-based, cross-sectional in design (65.4%), with sample sizes ≤300 (73%), and conducted predominantly in South India (50%). Most of them used a standard ABI cut off of ≤0.90 (84.6%) and handheld Doppler devices (48%). The prevalence of PAD ranged widely from 7% to 62%, with a pooled mean of approximately 31%. Hospital-based studies demonstrated a higher prevalence, with a mean of approximately 34%, when compared to community-based studies (~18%). Most patients with PAD had mild-to-moderate disease, and severe PAD (ABI <0.4) was relatively rare. The consistent risk factors included diabetes mellitus (≈85% of studies), hypertension (≈73%), dyslipidemia (≈56%), tobacco use (≈48%), and obesity (≈35%).

Conclusion: PAD is an important, yet largely undiagnosed vascular condition in India. Amidst the heterogeneity in study design and ABI methodologies, a consistent use of ABI ≤ 0.90 speaks to its reliability for the detection of PAD. There is an obvious need for nationally representative, community-based studies along with standardized measurement protocols of ABI to further strengthen the early identification and prevention strategies in high-risk populations.