Common condition, rarely recognized: Peripheral artery disease
January 11, 2016
Most of us know the drill when our doctor’s appointment starts. The nurse gets out the blood pressure cuff, straps it around our arm, and squeezes the inflation bulb.
But when we’re checking for a condition called peripheral artery disease (PAD), we also use blood pressure cuffs on your legs. It’s the same concept – we’re testing how well the blood is circulating to your limbs.
When someone has PAD, the arteries in the legs become narrow due to cholesterol blockages. As a result, circulation slows down, which leads to pain and weakness in the legs and an increased risk of coronary artery disease and stroke.
PAD (or more broadly peripheral vascular disease) is a common form of atherosclerosis, but it is one of the least recognized. One in every 20 Americans over age 50 has PAD. However, I’ve had patients as young as 30 years old who have developed PAD because of their lifestyle choices.
Pay attention to these risk factors and symptoms of PAD
PAD can be caused by a variety of factors:
- Age: PAD usually strikes patients after age 50.
- Tobacco use: Smoking and chewing tobacco are the biggest contributors to PAD.
- High blood pressure and high cholesterol: These conditions increase your risk.
- Diabetes: Affects circulation and plaque buildup in the arteries.
- Sedentary lifestyle: Lack of exercise heightens your chances of PAD.
Many people who experience PAD symptoms dismiss them as normal aging pains or neuropathy, a symptom of diabetes. Typical symptoms include a heavy feeling in the legs and cramping in the calves during exercise.
If left untreated, PAD can cause many serious problems, including:
- Leg pain that does not go away when you stop exercising
- Foot or toe wounds that heal very slowly or not at all
- Gangrene – the death of body tissue from decreased blood supply
- A noticeable difference in temperature in your lower leg or foot compared to the rest of your body
- Critical limb ischemia, a rare but severe symptom involving total loss of circulation of the leg and typically resulting in amputation
PAD is a red flag for future heart and cardiovascular problems. I’m involved with the international REACH registry, which monitors cardiovascular complications in patients around the world. We’ve found that people who have PAD are much more likely to develop coronary artery disease and/or suffer from a stroke.
How we diagnose PAD
We have a simple way to screen patients for PAD. We use the Rose questionnaire, which consists of two simple questions:
- Do you feel pain in your legs when you walk?
- When you stop walking, does the pain go away?
It seems so basic, but the questionnaire is a very effective way to identify patients who may have PAD. If you answer “yes” to these questions, the next step is to get a specific test called the ankle-brachial index (ABI) – that’s where the blood pressure cuffs come into play.
The ABI is a simple, inexpensive test – it takes just 10 minutes to perform. We measure your blood pressure with blood pressure cuffs on your arms and legs, and then we use a Doppler machine (rather than a stethoscope) to monitor your circulation. The Doppler uses sound waves to detect blood circulation and is sensitive enough to detect low blood flow in patients who might have PAD.
In the arms, a “normal” blood pressure is 120/80. The blood pressure in the legs is normally higher, but should be, at a minimum, about 90 percent of the blood pressure in the arms. People who have PAD can have leg blood pressure readings as low as 50 percent of the arm pressure readings.
How we treat PAD
Before we prescribe medication, we urge patients to stop using tobacco and start exercising.
Tobacco use is the most important risk factor for having PAD – smokers are four to six times more likely to develop the condition. Smoking also increases the likelihood that the disease and symptoms will be worse.
If you’re already a nonsmoker, exercise is the best thing you can do to treat or prevent PAD. Regular exercise helps keep your arteries flexible and flushes away cholesterol. In 2014, we presented findings to the American Heart Association that people who had a higher level of fitness in their middle ages were less likely to develop PAD 30 years later.
Your activity level also plays a major role in your risk for developing PAD. In early 2015, we published one of the first studies showing the association between a sitting/sedentary lifestyle and PAD. The more we sit, the more likely we are to develop PAD later on in life.
We also recommend adequate blood pressure control and statin medications for PAD patients. We’ve observed a 25 percent decrease in heart attack and stroke in PAD patients who take statins. Statins also reduce the risk for surgery to remove blockages and amputation in severe cases. Some patients also may be advised to take aspirin or blood thinners to improve blood circulation.
If patients still have pain in their legs despite these treatments, we sometimes perform procedures involving balloons and stents, or even surgery, to relieve the blockage.
If you’re concerned that you have or could develop PAD, talk to your primary care doctor, cardiologist, or vascular doctor about your symptoms and lifestyle. With the right balance of exercise, medication, and lifestyle changes, you can improve your condition and decrease your risk for future complications.