Peripheral Artery Disease: An Undertreated Threat
If you have peripheral artery disease, or PAD, chances are you could be doing more to improve your condition and lower your risk of serious complications. Fewer than half of Americans with PAD are treated with recommended lifestyle interventions, says a new study.
What is PAD?
Peripheral arteries run throughout the body, but PAD most often affects the arteries in the legs. PAD occurs when the arteries that carry blood to the legs become blocked from fatty and calcified plaque buildup, or atherosclerosis. The most common symptoms include pain or cramping in the leg or hip muscles when you walk or climb stairs. This discomfort is known as intermittent claudication.
Typically, the symptoms fade quickly when you stop moving because resting muscles don’t require as much blood flow. When PAD is severe, pain may persist after activity, slow-healing wounds may appear on the feet, and the lower portion of one leg may feel colder than the other leg.
However, many people with PAD have no obvious symptoms. It’s also common for older adults to dismiss PAD symptoms as an inevitable part of aging. But you should act on potential PAD symptoms because they can be the first warning of widespread atherosclerosis and heart disease.
Given PAD’s associated heart risks and high prevalence, preventing heart complications is a key component of PAD treatment. Some studies have shown that people with PAD are at higher risk for a heart attack, stroke, and early death than people with heart disease alone.
However, in a study published in the May 2017 issue of the Journal of the American College of Cardiology, only 20 percent of people (average age 62) with PAD received counseling on diet and exercise from their doctors, and just 36 percent received smoking cessation advice or medications.
On average, a little more than a third of the people in the study reported taking drugs recommended for PAD, even though treatment guidelines recommend drug therapy for almost all people with PAD. Overall, patients who saw a cardiologist for PAD got more risk-reduction therapy than those who visited their primary care doctor.
How to treat PAD
Now the good news: In most cases, PAD can be managed. Treatment guidelines recommend these steps to help prevent complications:
Cardioprotective drug therapy. Take antiplatelet agents, such as aspirin or clopidogrel (Plavix), as directed to prevent blood clots. Your doctor may also recommend other medications based on your risk factors, such as drugs for cholesterol, high blood pressure, or diabetes.
Regular physical activity. Engage in a structured exercise program, which includes walking, leg exercises, and treadmill exercises, to ease symptoms, supervised by a healthcare provider. Such programs typically alternate moderate to brisk activity and rest intervals to help you increase the amount of time you can walk without pain. You should feel improvement within two months. These programs have been underused because of their costs, but in May 2017 Medicare began covering supervised exercise programs for those with PAD.
- Smoking cessation. Programs and drug therapy are available to help you quit smoking. Also, avoid secondhand smoke. If your PAD is severe, you may need to undergo a vascular procedure, such as angioplasty, stenting, or bypass, to improve blood flow to the affected leg.
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