A common disorder that may affect as many as 12 million Americans at high risk for heart attack or stroke is often ignored or not diagnosed, according to a new study. Peripheral arterial disease (PAD) is a disorder that affects the arteries, usually in the legs, and can lead to painful leg muscle cramping or other signs of poor circulation due to the restricted blood flow that comes with atherosclerosis–hardening of the arteries.
Sometimes PAD is referred to more generally as peripheral vascular disease–PVD–but many experts now prefer to call the disorder PAD because it’s more accurate, says Alan T. Hirsch, MD, associate professor of medicine at the Vascular Medicine Program at the University of Minnesota Medical School. Hirsch led a team of researchers who looked at nearly 6,500 people across the country who had some risk factors for PAD, such as either being age 70 or older, or being between the ages of 50 and 69 and having a history of diabetes or smoking. The results of their study appear in the September 19 issue of the Journal of the American Medical Association.
Blood pressure in the study participants’ legs was measured using a special device and a scale called the ankle-brachial index, or ABI. The researchers found that many people had PAD but were unaware of it and were not being treated for the risk factor that it is.
It’s important for doctors to work with patients to prevent the consequences of cardiovascular disease while also improving the person’s symptoms and quality of life, Hirsch says. Treatment goals for people with PAD include
* Normalizing cholesterol levels.
* Attaining a healthy low blood pressure.
* Effective diabetes control.
* Quitting smoking.
* Starting a heart-healthy regimen like aspirin therapy.
And it’s important to start these efforts quickly, Hirsch says, to prevent cardiovascular events like heart attack or stroke. “With a PAD diagnosis, the clock is ticking faster toward a particular event,” he says. Others agree. The study shows that PAD can be an important sign of artery disease and can be easily diagnosed, which should lead to therapies designed to reduce risk factors, according to Kenneth Ouriel, MD, from the Department of Vascular Surgery at the Cleveland Clinic Foundation in Cleveland, Ohio. Ouriel is the author of an editorial that accompanies Hirsch’s study in the journal.
Doctors should be aware of the possibility that patients may have PAD, he says, and add the ankle-brachial test for potential PAD to their array of other tests. Ouriel compares the test for PAD to other simple, long-trusted tests for possible cardiovascular risk factors: The upper-arm blood pressure test is one example.
Hirsch says that the device used to measure ankle-brachial index is inexpensive as far as medical instruments go, and it is fast and easy to use. Not everyone needs to be checked for PAD, he says, but if they have risk factors or symptoms that may point to it–such as being over age 70; or 50 or older with a history of smoking or diabetes; or having nonhealing leg wounds; or leg pains that may indicate inadequate blood flow to the muscles–a test for PAD may be in order.
If doctors can regularly identify people with PAD, they can then help them start taking steps to reduce their risk factors, Ouriel notes. “Ultimately, practice changes such as these can be expected to improve the overall health status and life expectancy of elderly patients with atherosclerosis,” Ouriel writes.
Article By: Erin King, Medical Writer