Hard Facts Peripheral Arterial Disease Is A Common Precursor Of More Serious Heart Problems

Heart attacks and strokes strike millions of Americans each year. But the road to these often-fatal episodes is paved long in advance — often without any warning.
Take peripheral arterial disease (PAD), for example. This condition, similar to coronary artery disease and carotid artery disease, affects between 4.5 million and 7.5 million people at any given time, mainly those 65 and older.
Worse yet, the disease increases the likelihood of heart attacks and strokes fivefold. That’s the risk level of someone with a past heart attack or stroke in their medical history.

“It’s the same process that causes coronary artery disease, but the focus is on the narrowing of the peripheral blood vessels, as opposed to the blood vessels that supply the heart,” said Dr. Reed Shnider, director of Preventive Cardiology and Wellness at Baystate Medical Center. “So the intervention is similar to that used for coronary artery disease, and the symptoms are also related.”

Partly for that reason, most sufferers don’t even know they have peripheral arterial disease, or even what it is. Of those who have PAD — a condition marked by the buildup of fatty deposits along the arterial walls, affecting circulation — only 25{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} are undergoing treatment.

“While we are becoming more aware of diseases affecting the heart, most people are unaware of the disorders beyond heart attacks and stroke that fall under the cardiovascular umbrella,” said Dr. Augustus Grant, president of the American Heart Association (AHA) and professor of Medicine at Duke University Medical Center.

That’s a big umbrella, and most patients are never screened for PAD. But considering the statistics, it’s a matter of the heart worth keeping an eye on among the growing population of elderly Americans.

In the Flow

According to the AHA, peripheral arterial disease results from blockages in the arteries that supply the legs with blood, although it is less commonly found in the upper extremities as well. The risk factors are similar to those cited in other forms of circulatory disease, including diabetes, high blood pressure, high cholesterol, and smoking.

The problem is that most people with PAD do not recognize its typical symptoms. Many suffer from claudication, or a fatigue or pain in the leg muscles, which can lead to a walking impairment. Others might have a leg wound that will not heal. But these symptoms can reflect a number of disorders, while many PAD sufferers will show no severe symptoms at all — so communication between doctor and patient becomes important.

“It’s a marker of problems with the arteries in general,” Shnider said. “We’re really better at diagnosing coronary artery disease, and we’re not as attuned to PAD. Usually, interventions follow the development of symptoms. We don’t go looking for it as much as it comes along looking for us. If someone comes in with suspicious pain, we can do specific stress testing.”

Although doctors don’t screen for PAD with the same intensity they screen for other predictors of heart attacks and strokes, he added, it’s an important condition to discuss, especially for patients with key behavioral and health-history risk factors.

While anyone of retirement age is at risk, people age 50 and older are also at risk if they have a history of smoking or have diabetes. And while the blockage itself cannot be reversed, the rate at which it worsens can be slowed with lifestyle improvements — in fact, Shnider said, 80{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of patients will improve with smoking cessation and better control of diabetes and blood pressure.

“In my neck of the woods — prevention — it’s important to know about any manifestations of circulatory disease. That will affect how aggressive I am in instituting lifestyle changes and medical therapy to reduce plaque formation.”

Other interventions include the ankle-brachial bracelet, which is a measurement performed with an electronic stethoscope and a blood-pressure cuff. The test measures the blood pressure at the ankle and the arm, and if the blood-pressure reading is lower at the ankle, it suggests a blockage between the heart and leg — a sign of PAD.

In addition, Shnider said, “you can do ultrasounds and use sound waves to determine blood flow, you can do CT scans, MRIs, even angiograms if you want to get more invasive” to improve the flow. Also, according to the AHA, patients with claudication often benefit from a supervised exercise regimen of several walks or more per week.

Heart to Heart

Despite its low profile compared to heart attacks and even more widely discussed precursors such as congestive heart failure, Shnider said PAD is “a reasonable thing to talk about” as patients approach their retirement years.

“Heart attacks and strokes are more visible, but this is another manifestation of those problems,” he said. “We need to make people aware of lifestyle and wellness intervention and familiarize them with the fact that there are diagnostic tests that will let them know whether the pain in their lower extremities is circulatory.”

If it is, they’re certainly not alone — but they will have an edge on the millions who are unaware of this silent scourge.