Features October 2013 Issue

Soaring PAD Numbers Trigger Greater Focus on the Condition

Peripheral artery disease is often an indicator of coronary artery disease, too.

The rates of peripheral artery disease are climbing around the world, according to a recent study, and the news is prompting physicians to raise awareness of PAD’s causes and its often-misdiagnosed symptoms. PAD is similar to coronary artery disease (CAD), and is the result of narrowed or blocked arteries, usually in the legs, where it can lead to pain while walking and exercising.

An ankle brachial index device helps doctors diagnose PAD

The study, published in The Lancet, found that an estimated 200 million people worldwide have PAD, and the rate is climbing both in developed and underdeveloped countries. Raising awareness of PAD is critical, partly because it can lead to significant loss of mobility and even death, but also because it shares risk factors with CAD, the leading cause of death in the U.S.

“The risk factors for coronary artery disease and PAD have a high degree of overlap,” says Cleveland Clinic cardiologist and vascular specialist Heather Gornik, MD. “In fact, most patients with PAD do have some coronary artery disease, and many patients with coronary disease have PAD. If you have one of these problems, your doctor should evaluate you for the other problem.”

She adds that the major risk factors for PAD include smoking and diabetes, while hyperlipidemia, or unhealthy cholesterol levels, as well as high blood pressure are also contributing factors. Those same conditions also raise the risk of CAD.

Recognizing PAD
If you have any of those risk factors, you should be especially mindful of PAD’s symptoms, the most obvious of which is leg pain that develops while walking or exercising and eases with rest.

However, Dr. Gornik says it’s not uncommon for an individual to experience leg pain and chalk it up to muscle soreness, arthritis or just some random aches and pains associated with getting older. Another cause of leg pain is chronic venous insufficiency, a condition in which veins in the legs do not work properly and have trouble returning blood to the heart.

But she stresses that if your legs get sore after walking for a few minutes or 30 minutes, and that pain goes away when you sit down and put your feet up, you should see a doctor about getting tested for PAD.

Diagnosing and treating PAD
One of the main diagnostic tools used to identify PAD is an ankle brachial index (ABI), which is a ratio of the blood pressure in the lower legs to the blood pressure in the arms. A special blood pressure cuff, similar to the more familiar equipment used to check your arm blood pressure, is fitted around the lower leg.

A low ABI could indicate PAD. Depending on the degree of blockage in the peripheral arteries, your doctor may recommend lifestyle changes, such as quitting smoking, better blood pressure and cholesterol management, and improved diabetes control.

There are two primary medications used to treat PAD symptoms, and they are pentoxifylline and cilostazol, which is considered the more effective of the two drugs at treating claudication—the formal term for leg pain stemming from activity, Dr. Gornik says.

In some cases, stents may be placed in peripheral arteries where blockage is severe. And in the most serious cases, surgery may be required.

Call to action
In the Lancet study, the majority of people with PAD were found to be in low- and middle-income nations. “This is a great paper that shows that chronic disease and atherosclerotic disease is becoming as much of a health burden in developing and low-income countries as in developed countries,” Dr. Gornik says. “It reflects the fact that patients there are living longer and are developing more diseases of higher-income countries.”

But she emphasizes that everyone, regardless of where they live, is susceptible to PAD, and that managing risk factors and sharing possible symptoms with your doctor are the best strategies to preserve your health and independence.


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