By James B. Williams, MD
Peripheral arterial disease (PAD) is a term used to classify disease in the peripheral arteries, most commonly the arteries in the pelvis and legs. Simply stated, PAD is the buildup of plaque in the walls of arteries, which reduces or blocks the flow of blood through the legs. If blood flow is blocked to a part of the leg, then tissue beyond that point can begin to die because it is not being nourished with oxygenated blood. This can produce symptoms of pain in the legs, sores that do not heal, or toes that blacken — all of which, in advanced stages, can lead to amputation of a limb. Often, people with PAD do not experience any symptoms, and this makes it difficult to know there is a health concern that should be addressed.
PAD is progressive and incurable, affecting an estimated 8 to 12 million people in the U.S. alone. Interestingly, PAD affects the same number of Americans as cancer (11 million), but mortality rates associated with PAD are higher. Even though PAD is more prevalent than cancer in the U.S., only 20 to 30 percent of individuals with PAD receive treatment.
Risk factors
There are a number of risk factors associated with PAD; some of which are controllable. Key risk factors for PAD are listed below; smoking and diabetes top the list.
- Smoking: Smoking is the single most important, controllable risk factor for PAD. Smoking introduces high levels of lead and calcium into the body, which increases the risk of PAD. More than 80 percent of patients with PAD are current or former smokers. In smokers, PAD develops 10 years earlier, it is more likely to progress, and it doubles the risk of amputation.
- Diabetes: People with diabetes are two to four times more likely to develop PAD than non-diabetics, especially if they are over the age of 50. PAD is more severe and progresses more rapidly in diabetic patients; the risk increases in proportion to the severity of diabetes and its duration. With diabetes, nerves become impaired from increased blood sugar levels or a lack of receiving oxygenated blood, causing a condition called neuropathy. Patients with neuropathy have decreased sensation in their feet and legs, and their body has a more difficult time healing from injury and fighting infection. Therefore, diabetic PAD patients have a higher risk of amputation.
- Advancing age: The risk of PAD increases dramatically with age. Up to 20 percent of people 65+ years of age have PAD. Further, those 50+ years of age who also have risk factors for cardiovascular disease (e.g., high blood pressure or diabetes) — and people who smoke — are all more susceptible to PAD.
- High cholesterol: Excess cholesterol and fat in the blood contribute to the formation of plaque in the arteries. When this happens, there is reduced or blocked blood flow to the heart, brain, or limbs, which can lead to cardiovascular disease.
- History of cardiovascular disease: People with heart disease have a one in three chance of having PAD. PAD corresponds with a 40 percent increased risk of stroke, a 20 to 60 percent increased risk of heart attack, and an increased risk of death due to coronary events. Up to 80 percent of PAD patients die of cardiovascular causes. For these reasons, early treatment of the disease is critical.
- High blood pressure: Elevated blood pressure raises the risk of developing plaque in the arteries; it is important to manage high blood pressure to decrease the risk of PAD and other cardiovascular diseases.
- Ethnicity: Some ethnic groups (e.g., African-Americans, Hispanics) are more than twice as likely to have PAD.
Be sure to read part 2 of this article next month that covers the symptoms, diagnosis and treatment of PAD.
For information, contact the Cardiac Thoracic & Endovascular Therapies, S.C., at 309-680-5000. Dr. Williams is board-certified in three surgical specialists: cardiothoracic, vascular, and general. “Easy in, Easy Out” service advantages. Visit www.cvendo.com. Located at 2420 W. Nebraska Avenue, Peoria, IL.
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