As a young interventional cardiologist training in Boston, Dr. Pedro Martinez-Clark wanted to learn more about disparities in cardiovascular care for Black and Hispanic communities, especially when it came to peripheral artery disease (PAD).
His interest continued after he set up his practice in Miami, a community ripe for health care disparities given its significant Black population and Hispanics from diverse cultures in Cuba, Central and South America.
Socioeconomic factors and poor health habits can fuel PAD, which commonly involves a buildup of fatty plaque restricting the flow of blood to the lower extremities. Left unchecked or diagnosed too late, it can lead to preventable amputations. That’s not the worst of it: “Among those ages 65 and older, nearly 50% who underwent limb amputation died within one year after surgery,” the American Heart Association says.
PAD affects 8 million to 10 million American adults, including people with diabetes. In 2021, the Heart Association issued a paper calling for a 20% reduction in the country’s estimated 150,000 annual lower-extremity amputations by 2030. Last May, it partnered with the Journal of the American College of Cardiology on a joint guideline advocating “coordinated care from a multispecialty team” to reduce amputations and other cardiovascular issues. It also called for interventions “to address the disparity gap in amputation and revascularization procedures among people in diverse racial and ethnic populations.”
Martinez-Clark already was focused on such actions. He became involved in screenings, outreach and awareness programs, which he decided to formalize in 2022 by creating the Amavita Foundation.
Its first major project is the Miami Initiative to Stop Amputation, which launched just as last spring’s Heart Association guidance came out. The statement gave his initiative credibility, Martinez-Clark says, making it more than “an individual physician with an idea.” The initiative, he says, is “100% aligned” with the Heart Association goal.
“We feel we have made an impact, and we obviously have a huge mission in front of us. It’s a very exciting time." — Dr. Pedro Martinez-Clark
PAD is fueled by an unusual combination of diet, lifestyle and a kind of blind spot many primary care physicians have when it comes to diagnosis. Diabetes is among the most significant factors, but smoking and a diet heavy in pork or fried foods, things common within many Hispanic communities, can fuel losses in blood flow to the lower extremities, Martinez-Clark says. “I mean, Hispanic food is delicious, but it is not the most healthy from a cardiovascular perspective.”
PAD symptoms include leg pain when walking or ulcers — open sores on the leg or foot that heal slowly. But not all patients show those textbook conditions, and leg discomfort can have a number of causes including back issues and arthritis.
“It’s very surprising, but physicians are not very good at managing or identifying peripheral arterial disease even though it’s not a complicated condition to diagnose,” Martinez-Clark says. “But it does present with unusual symptoms that if you’re not thinking about it, it’s very easy to miss.”
The Amavita Foundation works with churches and community centers to host weekly screenings that attract dozens of patients. The screenings include an ankle-brachial index test, which checks blood pressure in a patient’s arms and ankles to see if there’s a significant difference. An ultrasound also can be used to help hear the blood flow in the arteries.
For patients developing PAD, life-style changes like quitting smoking, changing diets and adding a controlled exercise regimen can help tremendously. For more advanced cases, revascularization — most commonly done with a catheter — is a minimally invasive way to restore blood flow to the lower extremities, Martinez-Clark says.
He is optimistic the initiative will expand in 2025 with the help of new partnerships.
“We feel we have made an impact, and we obviously have a huge mission in front of us. It’s a very exciting time. We have made the right connections. We are getting the right attention, the right support, and I think it’s going to be very successful.”