Peripheral artery disease affects roughly 8 million Americans – and probably even more than that, considering many cases go undiagnosed. Called PAD for short and sometimes known as peripheral vascular disease, it’s a lesser-known cardiovascular disease in which plaque builds up in the leg arteries.So what does a disease that affects the legs have to do with the heart?
“If the leg arteries, which tend to be really big, are filling up with plaque, you can be pretty sure that the much smaller heart and brain arteries are also filling up with plaque,” said Deepak L. Bhatt, M.D., M.P.H., chief of cardiology at the VA Boston Healthcare System and an American Heart Association volunteer. Decreased blood flow to those critical organs increases risk for heart disease and stroke.
PAD affects as many as one in five Americans ages 65 and older. Yet it often goes undetected because it doesn’t always have symptoms. When PAD symptoms do show, they are vague: pain, cramping or tiredness in the legs after walking or climbing stairs. People often wrongly self-diagnose, blaming arthritis or aging.
Even a visit to the doctor can leave PAD undiagnosed.
“I’m not sure that every physician is thinking of it and screening for it,” said Bhatt, who also heads the integrated interventional cardiovascular program at Brigham and Women’s Hospital and the VA Boston Healthcare System. Even if a person comes in complaining of leg symptoms, the list of possibilities is so long that it’s easy to overlook PAD, Bhatt said. “If a patient isn’t having symptoms, physicians may not look at all.”
The solution is simple: foot pulse. A thorough physical exam for an adult should include assessment of the pulses in the feet using the standard ankle brachial index (ABI) as well as several other diagnostic tests for PAD, followed by further evaluation if they’re abnormal, Bhatt said. A diagnosis of PAD may be the only clue that plaque could also be accumulating in the heart or brain arteries.
Heart disease and stroke patients would benefit from knowing whether they have PAD and taking steps to treat it. If left untreated, PAD can lead to gangrene and amputation.
As people get older, plaque tends to build up in the arteries. But exactly when problems occur depends on a person’s lifestyle – things like diet,exercise, smoking, diabetes, high blood pressure or high cholesterol. “Healthy living goes a long way toward preventing or at least delaying buildup,” Bhatt said.
Lifestyle changes go a long way in PAD prevention and treatment.
Once a diagnosis is made, the first step for a smoker is to quit smoking. Other lifestyle changes include eating a healthy diet and starting a supervised walking program.
Patients should walk until pain sets in and then push a little beyond that, Bhatt said. After a brief rest, they start the cycle again. “If they do that with enough regularity over the course of several months, many times, the patient’s ability to walk and the distance they can walk improves,” he said.
Although walking may be the last thing a PAD patient wants to do, it’s actually the most effective way to treat it and ease pain. Regular exercise helps the body form natural bypasses around the blocked artery that keep the leg and foot alive.
Medication also helps.
Doctors typically prescribe cholesterol-lowering statins and antiplatelet therapy to reduce the risk of blood clots that could lead to a heart attack or stroke.
If these strategies aren’t enough, minimally invasive procedures may be needed to open the clogged artery or to remove a clot that’s blocking the artery. For severe cases, surgery may be needed to reroute blood flow around a closed artery.
Bhatt expects the number of Americans diagnosed with PAD to climb as more people become aware of the disease. “There’s a lot that can be done,” he said. “But it all hinges on the diagnosis being made.”