Have you ever had to cut short a day of shopping or sightseeing because of severe leg pain? Maybe you’ve given up golf because you can no longer walk the course.
Pain or discomfort in the legs is a common symptom of a disease called peripheral arterial disease (PAD). Up to 8-12 million Americans have PAD. Peripheral arterial disease is atherosclerosis that develops in the arteries of the legs or, less commonly, the arms. Like atherosclerosis in the heart (coronary) arteries, PAD is caused by the accumulation of fatty plaque in the blood vessel walls. As plaque builds up, the blood vessels get narrower and narrower, until they become blocked. In the coronary arteries, atherosclerosis causes chest pain or a heart attack. In the legs, atherosclerosis can cause pain, weakness, or fatigue while walking.
The dangers of PAD extend well beyond difficulties in walking, and the consequences can be far worse than missing a shopping trip or golf game. Peripheral artery disease increases the risk of developing a non-healing sore of the legs or feet. In cases of severe PAD, these sores can develop into areas of dead tissue (gangrene) that ultimately require amputation of the foot or leg.
The effects of PAD can extend beyond the affected limb. The body’s circulatory system is interconnected. Patients with atherosclerosis of the legs commonly have atherosclerosis in other parts of the body. Therefore, it’s not surprising that patients with peripheral artery disease are at increased risk for having a heart attack, stroke, transient ischemic attack (“mini-stroke,”) or problems with the kidney (renal) arteries.
Who Gets PAD?
Although PAD is a different condition than coronary artery disease, the two are related. People who have one are likely to have the other: the National Institutes of Health estimates that a person with PAD has a six to seven times higher risk of coronary artery disease, heart attack, stroke or a transient ischemic attack than the general population; a person with heart disease has a 1 in 3 chance of having peripheral artery disease in the legs (1).
Not surprisingly, the two diseases also share some common risk factors. This is because these risk factors cause the same changes in arteries in the arms and legs as they do in the coronary arteries.
PAD risk factors include:
- Age over 50
- High blood pressure
- High cholesterol
- Abdominal obesity
- Kidney disease (both a risk factor and a consequence of PAD)
Other risk factors for PAD include race – African Americans have about two times the risk for PAD as Caucasians or Asians – and a family history of heart disease or PAD.
Both woman and men are at risk for developing PAD.
As in coronary artery disease, many of these risk factors are out of your control. But, according to researchers at Cleveland Clinic (2), smoking is the single most important modifiable (changeable) risk factor for PAD and its complications. Smoking increases the risk for PAD by 400 percent and brings on PAD symptoms almost 10 years earlier. Compared with non-smokers of the same age, smokers with PAD are more likely to die of heart attack or stroke, have poorer results with heart bypass surgery procedures on the legs and are twice as likely to have a limb amputated.
Diabetes is another strong risk factor for PAD in women. When combined with other, common conditions related to diabetes such as heart disease, nerve problems in the legs and feet, visual problems, obesity and depression, adding PAD to the mix increases the likelihood that a diabetic woman will have serious mobility problems.
Taking Control of Peripheral Arterial Disease
Despite the prevalence of PAD, it is surprisingly underdiagnosed and undertreated (3). The good news is that, although PAD is a serious condition with potentially serious consequences, it is treatable. Like most health conditions, PAD is more treatable when it is detected early.
Being aware that you have risk factors for PAD may motivate you to take action to prevent PAD from developing. The same advice for maintaining a healthy heart applies to maintaining healthy circulation overall:
- Manage your weight
- Eat a low fat, low sugar diet that includes at least five servings of fresh fruits and vegetables every day
- Don’t smoke.
- With your doctor’s approval, exercise, doing an activity you enjoy, for at least 30 minutes a day on most days of the week.
If you have heart disease, you should discuss your risk factors for PAD with your doctor and report any symptoms you are having such as pain, weakness or numbness in the legs. Your doctor may order a simple test, known as the ankle-brachial index (ABI), to diagnose PAD The ABI test involves measuring the blood pressures in the arms and the legs using a hand-held Doppler device.
If you already have mild PAD, your doctor may prescribe exercise therapy, dietary changes, smoking cessation and medication. Common medications prescribed for atherosclerosis and PAD include anti-platelet agents (such as aspirin or clopidogrel) and cholesterol lowering medications (“statins”). The best things that you can do for yourself in this situation are to quit smoking, control your high blood pressure, take your medications, and manage your diabetes.
It is also very important that patients with PAD take especially good care of the feet to prevent non-healing sores. Important components of foot care for patients with PAD include: wearing comfortable, appropriately fitting shoes; inspecting the feet regularly for sores; keeping the feet clean and well moisturized; and, taking regular care of the toe nails. In some cases, a patient with PAD is referred to a podiatrist for specialized foot care.
Other Treatments for Peripheral Arterial Disease
More advanced PAD that is causing severe pain and limited mobility may require endovascular (i.e., minimally invasive) or surgical treatment. Some of the same treatments that are used for heart disease are also used for treating PAD.
In this procedure, a miniature balloon is passed through a catheter into the arteries. As the balloon is expanded inside the artery, it pushes against the plaque and opens up the artery.
These are tiny metal support coils that are inserted into the arteries. Once they are in place, stents expand against the inner blood vessel wall to support it and hold it open. Stents can be placed through a small opening using catheters (long, thin tubes) without major surgery.
Similar to heart bypass, a surgeon uses a section of the patient's healthy vein or a synthetic replacement to create a bypass around the blocked area in the leg artery. This is usually reserved for the most severe PAD.
With early diagnosis, lifestyle changes and treatment, you can stop PAD from getting worse. In fact, some studies have shown that symptoms due to PAD can be reversed with exercise combined with careful control of cholesterol and blood pressure. If you think you are at risk for PAD or may already have the disease, talk to your primary care doctor or cardiologist so that you can get started on a prevention or treatment program as soon as possible. With proper diagnosis and treatment, you can still enjoy the good things in life - like shopping, sightseeing and golf!
For questions or more information about PAD, call the Miller Family Heart & Vascular Institute Resource and Information Center Nurse at 216.445.9288 or toll-free 866.289.6911. For an appointment with a Cleveland Clinic women’s heart or vascular specialist, call toll-free 800.223.1696 or locally, 216.444.9343.
- What is Peripheral Artery Disease? National Heart, Lung and Blood Institute. www.nhlbi.nih.gov/health/dci/Diseases/PAD/PAD_what.html
- Bartholomew J, Olin J. Pathophysiology of peripheral artery disease and risk factors for its development. Cleveland Clinic Journal of Medicine 2006;73:S8-S13.
- Volpato S, Blaum C, Resnick H, Ferucci L, Fried L, Guralink J. Comorbidities and impairments explaining the association between diabetes and lower extremity disability. Diabetes Care 2002;25:678-683.
Additional reading about PAD:
Reviewed by Dr. Heather Gornik