Features November 2011 Issue

Understand Your PAD Risk If You Have Other Vascular Problems

New guidelines suggest a greater awareness of peripheral artery disease if you have coronary artery disease.

An estimated one in five Americans over age 70 has some form of peripheral artery disease (PAD), yet the vast majority of older adults know little about the condition.

The American Heart Association (AHA) reported in September that only 26 percent of Americans older than 50 know anything about PAD.

“I’m not surprised by the statistic,” says Cleveland Clinic vascular specialist Heather Gornik, MD, a strong advocate for raising public awareness of PAD. “There is a tremendous under-awareness of PAD as a serious health problem in older adults. This has been the focus of a major awareness campaign. In this same study, they found that Americans were much more aware of rare diseases, such as Lou Gehrig’s disease or cystic fibrosis.”

Earlier this year, the European Society of Cardiology updated its guidelines for treating PAD, as did the AHA and the American College of Cardiology (ACC). In both cases, doctors stress the importance of raising awareness among patients and physicians about the risks of PAD if you have vascular disease elsewhere in the body.  The National Heart, Lung and Blood Institute reports that your odds of developing PAD are better than one in three if you have coronary heart disease (CHD).

Likewise, if you have already been diagnosed with PAD, your odds of having CHD or other vascular complications, such as carotid artery disease, are also increased significantly.

Screening for PAD
PAD is a condition in which the arteries that carry blood to your head, limbs and organs become narrowed due to plaque build-up. That means less blood is circulating through those areas, eventually causing harm to the tissue there. And muscles, for example, experiencing a deficit of oxygen-rich blood can be painful. PAD is frequently experienced in the legs, and a common symptom is pain from walking or other activities.

If you start to feel pain in your legs or feet after walking­—it could be after five minutes or much longer—you should tell your doctor and ask about a PAD screening, Dr. Gornik says. This is especially true if you’ve had any other vascular problems in the past.

And even if you’re not having symptoms, Dr. Gornik suggests a simple PAD screening just to keep an eye out for any potential problems.

The initial screening for PAD is an ankle-brachial index (ABI) test, which simply measures the blood pressure in both arms as you usually have it tested, and the blood pressure at both ankles. It’s painless and is generally accurate and reliable. Patients with diabetes or kidney disease, however, may have especially rigid arteries that make it more difficult to get accurate blood pressure readings.

“I think it’s important to diagnose PAD even among asymptomatic patients,” she says. “The AHA/ACC recommends an ABI test for individuals above the age of 70 or those above 50 who have diabetes mellitus.”

Dr. Gornik adds, however, that some insurance carriers won’t cover screenings in all circumstances. So you may need to inquire first if you will be covered based on your age, doctor’s recommendation and insurance plan.

Progression of PAD
If you are diagnosed with PAD, your doctor will review the medications you’re taking and decide if another medication should be added. Typical first-line PAD medications include blood thinners and those designed to lower your blood pressure and cholesterol.

You’ll also be encouraged to exercise, which should promote better circulation throughout your body. If just walking up the stairs is painful, you may not like the idea of forcing yourself to get up and move, but physical activity can help extend the time you can be on your feet before pain sets in. Such an exercise program would be supervised and your symptoms monitored.

The pain associated with PAD is called claudication, and it’s difficult to predict whether your condition will remain stable for a while or become more serious.

“In most cases PAD progresses slowly,” Dr. Gornik says. “But a subset of patients can progress rapidly to critical limb ischemia, which is a severe lack of blood flow to the leg. That leads to pain, even at rest, and to non-healing sores, or even gangrene.”

Risk factors for rapid progression include older age, diabetes and ongoing tobacco use.