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Peripheral artery disease often goes untreated

Problems in arteries supplying the legs, kidneys, and elsewhere pose problems for the heart, too.

The arteries that supply the heart (coronary arteries) and the brain (carotid arteries) get far more attention than the vast network of arteries below the heart. These so-called peripheral arteries are often overlooked — and a study suggests that problems in these blood vessels are often undertreated — even though they cause as much mayhem as problems in the coronaries and carotids.

“Peripheral arteries” is an unfortunate catchall term that undervalues these vital sections of the circulatory system. They include the lower part of the aorta (the main pipeline for oxygenated blood out of the heart), as well as blood vessels that supply the stomach, intestines, kidneys, liver, arms, and legs.

Atherosclerosis, the disease process that clogs coronary and carotid arteries with cholesterol-filled plaque, also affects peripheral arteries. By restricting blood flow, it can cause

  • claudication, a potentially disabling leg pain that occurs with walking or exercise

  • gangrene, which often requires amputation of a limb

  • abdominal pain after eating

  • permanent damage to the bowel.

Another manifestation of peripheral artery disease is abdominal aortic aneurysm, the ballooning of a weakened patch of the aorta. The rupture of such an aneurysm can be deadly.

In many people, peripheral artery disease causes no outward signs or symptoms. Sometimes it is detected by chance, revealed by a test for something else. Other times a doctor goes looking for it using a measurement called the ankle-brachial index that compares blood pressure at the ankle with blood pressure in the arm. In healthy people, these two should be almost the same, giving an ankle-brachial index of 1.0. Lower blood pressure at the ankle (an ankle-brachial index under 0.9) indicates peripheral artery disease.

Should you be tested?

If just one in every 17 American adults has peripheral artery disease, it doesn’t make sense for everyone to be checked for it. Instead, the latest guidelines on diagnosing and treating this condition recommend testing if you

  • have leg pain while walking that goes away when you rest

  • have heart disease, carotid artery disease, or kidney trouble

  • have a parent, sibling, or other close relative who has or had peripheral artery disease

  • are under age 50 and have diabetes and one other risk factor for atherosclerosis, such as high blood pressure or high cholesterol

  • are between the ages of 50 and 69 and you smoke or have diabetes

  • are over 70 years old.

The guidelines also recommend a one-time ultrasound of the abdomen for older individuals who have ever smoked or who have a parent or sibling with an abdominal aneurysm.

Your doctor should be able to do the necessary tests. Or you can avail yourself of the Legs for Life program sponsored by the Society of Interventional Radiology. Every September, it offers free clinics around the country. Participating doctors check all comers for peripheral artery disease and abdominal aortic aneurysm. You can get more information about the program at www.legsforlife.org.

Disease often untreated

Local treatments, such as procedures to bypass or open diseased peripheral arteries, can ease symptoms. But they don’t fix the problem. Peripheral artery disease must be attacked on all fronts. That means taking steps to halt or reverse atherosclerosis and to stabilize plaque so it doesn’t erupt — the event that kicks off most heart attacks and strokes. This includes healthy lifestyle choices and artery-protecting medications.

A study suggests that most people with peripheral artery disease aren’t taking such medications. Using data from the National Health and Nutrition Examination Survey, researchers from Harvard-affiliated Brigham and Women’s Hospital estimated that at least two-thirds of the seven million American adults with peripheral artery disease aren’t taking a statin, an ACE inhibitor, and/or aspirin, medicines known to protect arteries and the heart (Circulation, July 5, 2011).

Clogging, stiffening, or weakening in arteries supplying the legs or other body parts almost always means problems elsewhere in the arterial network, including in the heart. The Brigham and Women’s study offers strong motivation for people with peripheral artery disease to put some energy into cardiac protection. Over the course of the four-year study, 23% of the participants with peripheral artery disease died, compared with 5% of those without the condition.

An all-out assault on peripheral artery disease might look like this:

  • not smoking

  • exercising

  • eating a diet that emphasizes healthy fats, whole grains, fruits and vegetables, fish and other lean protein, and minimal salt

  • taking medications as needed to keep blood pressure and cholesterol in check and to protect the arteries.

Posted by: Dr.Health

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