Risk Factors of Peripheral Arterial Disease
Todd Guynn, M.D.
University Cardiovascular Surgeons
Peripheral arterial disease (PAD) affects millions of people in the United States.
The most common cause of PAD is atherosclerosis, which is the buildup of plaque on the inside of the arteries. The plaque deposits decrease the space through which oxygen-rich and nutrient-rich blood can flow. Poor blood flow "starves" the muscles and other tissues in the lower body. Reduction in blood flow often results in intermittent claudication, which is tightness or squeezing pain in the calf, thigh or buttock during exertion.
In general, people with PAD have an increased risk of heart attack, stroke, amputation of lower extremity limbs and death. In fact, a patient with PAD has about five times the risk of dying of a heart attack or stroke over the next ten years as the patient who does not have peripheral arterial disease.
Family history of arterial disease is perhaps the greatest risk factor to any individual.
Risk factors for PAD are much the same for cardiovascular disease, which include age, smoking, obesity, hypertension, diabetes, and physical activity.
African Americans also have a higher risk level of developing PAD.
To help reduce your risk, you can:
- Manage stress: Stress may be a direct contributor to poor heart health because it can increase blood pressure.
- Quit smoking: Smoking accelerates atherosclerosis, the major cause of PAD and stroke.
- Control chronic depression: Depression has been linked with a higher risk of developing high blood pressure, heart disease, and having a heart attack.
PAD is often overlooked, undertreated, and the disease rarely offers early warning signs.
Only about a third of those afflicted have leg pain from PAD. Symptoms can include pain, ache, cramp or severe fatigue in one or both legs when walking. In the later stages, leg circulation can become so poor that pain occurs in the toes and feet during periods of inactivity, and the blockage can lead to gangrene, ulcers or the loss of the foot or limb.
PAD can be readily diagnosed by an abnormal value of the ankle-brachial index (ABI). ABI is a measurement performed with an electronic stethoscope and a blood pressure cuff. The test measures the blood pressure at the ankle and arm. The pressure is then compared at these two areas.
A blood pressure that is lower in the ankle than the arm implies a blockage in the artery between the heart and the leg. This type of blockage suggests peripheral arterial disease.
In addition to ABI, there are several other tests that may be required to diagnose PAD, and to determine the extent of the disease including:
- Complete medical history and physical exam
- Treadmill exercise test
- Segmental pressure measurements of the legs
- Duplex arterial imaging or ultrasound imaging
- Conventional angiogram
- Computer Topographic Angiogram (CTA)
- Magnetic Resonance Angiogram (MRA)
Early diagnosis and treatment of PAD is important not only to preserve the health of the limbs, but also to decrease the risk of heart disease, stroke, and other health problems.