Ask the Experts - PAD

Patrice Desvigne-Nickens, MD, is medical officer, heart failure and arrhythmia branch, Division of Cardiac Diseases, National Heart, Lung and Blood Institute

Q: What is peripheral arterial disease (PAD) and how many people have it?

A: PAD is blockage in the blood vessels of the limbs, most commonly the legs. It’s caused by plaque, a fatty deposit that builds up inside arteries and obstructs blood flow. Normally, blood flows through the arteries to the capillaries where it deposits oxygen and nutrients in leg tissue. Plaque in the arteries keeps the blood from getting the necessary oxygen and nutrients to leg tissue, which causes damage. PAD affects 8 to 12 million Americans, and as many as 20% of people 65 and older. PAD is expected to become even more common as the baby boomer generation ages. African-Americans are twice as likely as whites to have PAD, and the risk is also higher in Hispanics.

Q: What causes PAD—and how dangerous is it?

A: PAD puts you at greater risk of heart attack, stroke, and amputation. Many people with PAD do not connect it with these life-threatening conditions. The plaque that clogs arteries usually develops because of elevated cholesterol, diabetes, or high blood pressure. Some people experience gnawing pain when they exercise, and they stop exercising to prevent the pain. As plaque continues to build, sores or ulcers appear and can develop into gangrene (tissue death). When that happens, the leg may have to be amputated.

Q: Why is PAD sometimes called a “silent” disease and what symptoms signal its presence?

A: PAD is called a “silent” disease because you can have partial blockage in your arteries and have no noticeable symptoms. By the time symptoms appear, the disease may already be advanced. Signs and symptoms may include poor circulation to the legs; thin, shiny skin; loss of hair; and a change in skin color. Symptoms of advanced PAD may include severe pain and sores or ulcers that are difficult to heal.

Q: Does PAD run in families?

A: Family history is very important in predicting who might have PAD. If your family history includes diabetes, high blood pressure, or elevated cholesterol, ask your doctor about your PAD risk.

Q: How is PAD diagnosed and treated?

A: Your doctor will ask about your medical history and give you a thorough physical exam. There is a simple test called the ABI—ankle brachial index—that indicates whether your blood pressure is the same in your ankle as in your arm. A lower reading in the ankle may mean that there are blockages in the leg, and the doctor may want to perform additional tests. Some cases of advanced PAD may be treated by surgery, but surgery doesn’t always solve the problem.

Q: Is there anything I can do to prevent PAD?

A: Yes! Here are some tips:

• If you don’t smoke, don’t start. If you smoke, quit.
• Eat healthy foods, and keep your weight at a healthy level.
• Exercise regularly—keep moving!
• If you have diabetes, high blood pressure, or elevated cholesterol, be sure to take your medications as prescribed by your doctor. Keeping these conditions under control can help prevent the build-up of plaque in your arteries.

Q: If I think I—or someone I care about—might have PAD, what should I do?

A: The key is to determine whether a person is at risk for the condition. Many people have aches and pains in their legs that get worse with exercise and that keep them awake at night. People often think these problems are just signs of aging and that nothing can be done. If that’s the case, don’t ignore the symptoms. Talk to your doctor so you can make changes that can prevent the progression—or even reverse the effects—of PAD.