Why is it Important to Know if You Have PAD?
Facts about PAD
What is Peripheral Arterial Disease (PAD)?
What are the Symptoms of PAD?
Are You at Risk for PAD?
How Can You Reduce Your Risk for PAD?
What is a PAD Screening Exam?
PAD References
Why is it Important to Know if You Have PAD?
Peripheral arterial disease (PAD) results in poor blood circulation to the arms and legs. PAD occurs when the arteries in your legs become narrowed or blocked by plaque. Untreated, PAD can lead to severe disability, including limited mobility and, in severe cases, limb amputation.
Futura Health Screening offers PAD screening to the public to detect those individuals at high-risk for PAD so that they can have the best chance to avoid or reduce complications from PAD. PAD, in most cases, can be controlled through early detection, education, medical treatment and risk factor modification.
PAD affects about 8 million men and women in the United States(1). The prevalence of PAD increases dramatically with age and disproportionately affects blacks(1). Smoking or having diabetes increases one’s chances of developing the disease sooner.
Facts about PAD
- About 8 million men and women are affected in the United States(1).
- One in every 20 Americans over the age of 50 has PAD(2)
- PAD affects 12-20% of Americans age 65 or older(1).
- PAD is assoicated with increased risk of heart attack and stroke(1).
- Smoking or having diabetes increases one’s chances of developing the disease sooner.
There may be no symptoms in the very early stages of PAD; however, if left untreated, the disease may advance to a point where it can become lifestyle limiting and limb threatening (i.e. amputation). About 40% of persons do not complain of leg pain or other symptoms of PAD(1). The test for PAD is a painless screening exam that can detect PAD in its early stages, where treatment and lifestyle modification can prevent the advancement of the disease.
PAD in the legs is an indicator for possible atherosclerotic disease (plaque buildup) anywhere in the body. If it involves the coronary arteries, PAD can lead to a heart attack or if involving the arteries supplying the brain PAD can lead to stroke. Individuals with PAD suffer a five-fold increased relative-risk of a stroke; the total death rate is two to three times greater for individuals with PAD(4). The risk factors for PAD are similar to those for coronary heart disease and stroke, although diabetes and cigarette smoking are particularly strong risk factors for PAD. If you have PAD in your legs, you are at greater risk of heart attack, stroke and death.
Most important is the fact that if PAD is identified, opportunity exists for you to work with your physician to modify risk factors and seek further treatment as appropriate, thus empowering you to choose a lifetime of good health.
What is Peripheral Arterial Disease (PAD)?
Peripheral arteries are the blood vessels that provide oxygenated blood to the arms and legs (upper and lower extremities). Healthy peripheral arteries are smooth and unobstructed, allowing adequate blood flow to the extremities both at rest and during periods of increased demand, such as physical activity like walking or exercise.
PAD results in damage and dysfunction of the arteries that can result in reduced blood flow. The most common cause of PAD is atherosclerosis, where cholesterol and fatty substances build up in the walls of the arteries forming what is referred to as “plaque”. Eventually, plaque can result in loss of flexibility and narrowing of the arteries, reducing or completely obstructing the flow of blood.
Graphics Courtesy of U.S. Dept of Health and Human Services
What are the Symptoms of PAD?
In the early stages of PAD there may be no symptoms since the plaque does not result in a severe enough narrowing to cause a reduction in the blood supply to the extremities. As PAD advances, the amount of narrowing produced by the plaque can increase to the point where there may still be adequate blood supply at rest (i.e. when demand is low), but not enough when during exercise (i.e. when demand is increased). In the most advanced stages of PAD, the amount of narrowing can reach levels where there is inadequate blood supply even at rest.
Intermittent claudication is the most common symptom of PAD and is characterized by fatigue, tiredness, or a cramp-like pain occurring in the calf, thigh or buttock when walking. The symptoms typically occur consistently upon walking a specific distance (e.g., 1 block, 3 blocks, etc.) and resolve with a short amount of rest. Individuals who claudicate, although having adequate blood supply to the extremities at rest, have insufficient supply of oxygenated blood to the muscles upon exertion, leading to the temporary pain and discomfort.
Rest pain is a persistent severe ache in the foot that is present at rest. It often times worsens when the leg is elevated (e.g., when lying down in bed) and may be relieved by dangling the leg and foot wherein blood flow is aided by the effects of gravity. Rest pain usually indicates more advanced PAD.
Slow healing ulcers are wounds that are slow to heal or do not heal due to compromised or inadequate arterial blood flow. They are often precipitated by infection or trauma and occur over the lower legs, feet and toes.
Gangrene or “death of tissue” represents the most advanced stage of PAD and occurs when nutrition required for normal growth and repair of tissue can no longer be provided due to severe and extensive narrowing or complete blockages of the lower extremity arteries. Gangrene can be wet (associated with infection) or dry and ultimately results in a black discoloration of the affected area.
Are You at Risk for PAD?
Risk factors are traits and lifestyle habits that increase the risk of disease. Having any of these risk factors does not mean that you will have PAD, but you can take steps to help prevent the disease. Some risk factors can’t be changed such as aging and family history of stroke, heart disease or PAD. However, there are other risk factors that can be changed, treated or controlled.
- Cigarette smoking
- Diabetes
- High blood pressure (Hypertension)
- Blood pressure is considered high if it stays at or above 140/90 mmHg over time(2).
- Unhealthy blood cholesterol levels
- Total blood cholesterol should be less than 200 mg/dL.
- LDL (“bad” cholesterol) should be less than 100 mg/dL.
- HDL (“good” cholesterol) should be 40 mg/dL or greater for men and 50 mg/dL or greater for women.
- Race
- Blacks are more than twice as likely as whites to have PAD(5).
- Obesity
- Physical inactivity
- Age older than 50
- Family history of heart disease, stroke or PAD
How Can You Reduce Your Risk for PAD?
By choosing to reduce your risk factors, you can prevent or delay PAD and its complications.
- Know your blood pressure
- High blood pressure usually has no signs or symptoms.
- See your doctor to get your blood pressure checked, at least once each year.
- Work with your doctor to keep your blood pressure under control.
- If you smoke, stop!
- Know your blood cholesterol level
- Abnormal cholesterol levels usually have no signs or symptoms.
- If abnormal, control by medication, diet and/or exercise.
- Control your diabetes
- Work with your doctor to keep your diabetes under control, through nutrition, lifestyle changes, and medicine.
- Eat a healthy diet.
- A diet containing five or more servings of fruits and vegetables per day may reduce the risk of stroke.
- Eat foods that are low in total fat, saturated fat, trans fat, and cholesterol to help control blood cholesterol levels.
- Reduce sodium (salt) intake to help control blood pressure.
- Reduce your calorie intake to help avoid becoming obese.
- Exercise every day
- Try to get a total of at least 30 minutes of activity on most or all days.
- Talk to your doctor about what types of activity are safe for you.
- See your doctor regularly
What is a PAD Screening Exam?
PAD screening evaluates your risk for PAD through a risk factor assessment and measurement of resting ankle/brachial indices (ABI’s). A resting ABI test is painless and is used to detect the presence of PAD that is producing a measurable change in the blood flow to the lower extremities at rest. The test involves placement of blood pressure cuffs over both upper arms and around both ankles. Part of measuring the arm and ankle blood pressures involves the use of an ultrasound probe or transducer that allows the technologist to “listen” to blood flow (as opposed to using a stethoscope).
Once measured, the pressures are compared by dividing the ankle pressure by the arm (or brachial) pressure. Normally the ankle pressure is equal to or greater than the arm pressure (an ABI of 0.90 is considered normal). However, in the presence of significant PAD, the ankle pressure is lower than the arm pressure resulting in an ABI of 0.90 or less, in which case further diagnostic testing should be considered.
The screening exam will only take about 10-15 minutes. A final report will be mailed to you and your primary care physician within 10 working days. If critical results are found, we will contact your primary care physician before you leave.
References
1 “Heart Disease & Stroke Statistics – 2010 Update.” American Heart Association. American Heart Association, 2010. Web. 2 Jul 2010.
2 “Peripheral Arterial Disease (P.A.D.), Facts About, NHLBI.” National Heart Lung and Blood Institute. National Institutes of Health, 08/2006. Web. 14 Jul 2010.
3 “Peripheral Artery Disease (PAD).” VascularWeb. Society for Vascular Surgery, 01/26/2010. Web. 14 Jul 2010.
4 “SVS Position on Vascular Screening.” VascularWeb. Society for Vascular Surgery, 01/2011. Web. 17 Mar 2011.
5 “Peripheral Arterial Disease, Who Is At Risk.” National Heart Lung and Blood Institute. National Heart Lung and Blood Institute, n.d. Web. 14 Jul 2010.
6 “Stroke Risk Reduction – High Blood Pressure.” National Stroke Association. National Stroke Association, 2009. Web. 9 Jul 2010.
