How serious is peripheral artery disease (PAD)? We all know that plague in arteries near the heart can lead to heart attack and plaque in the arteries of the neck and brain can lead to stroke.

With PAD, plaque is typically found in arteries that supply blood to the legs-an indication that blood flow also may be inhibited throughout the body, which increases risk for heart attack and stroke, as well as severe disability or loss of a limb.

Doctors have long been aware of PAD, but the disease has received relatively little attention because patients either don't have symptoms or have only mild or moderate ones that are wrongly attributed to normal signs of aging.

What's new: The link between PAD and cardiovascular disease is now so strong that virtually all doctors agree that a diagnosis of PAD warrants a checkup and monitoring by a vascular specialist.

What you need to know to protect yourself or a loved one...

Are you at risk?

PAD is surprisingly common. It affects up to 10 million Americans. Because PAD is associated with the same risk factors as heart attack and stroke, the risk for PAD is higher among adults who are over age 50 and/or people who have elevated cholesterol or high blood pressure.

Having diabetes doubles the risk of developing PAD. Prediabetes also increases risk. But the greatest risk comes from smoking. At least 80% of people with PAD are current or former smokers. Statistically, the worst combination is smoking and having diabetes-when combined, they increase the risk of developing PAD fivefold.

Symptoms can be tricky

PAD is dangerous because it can creep up on you without causing symptoms. In fact, up to half of people with PAD do not have symptoms.

When symptoms do occur, they start out mild and may be easy to dismiss. Because blood flow is compromised, activities that involve the use of the legs-walking, for example-can become more difficult and feel more tiring.

As plaque blockages become more severe, PAD causes intermittent claudication-legs become painful or achy or cramp up while walking.

At first, a person with PAD may experience symptoms of intermittent claudication only after walking long distances or up a hill or while climbing stairs. The discomfort usually goes away after sitting down and resting for a few minutes. If the condition is left untreated, even a short stroll will trigger the pain.

What most people don't know: In rare cases, PAD can occur in the hands and arms, leading to symptoms such as aching or cramping in the arms.

Getting a proper diagnosis

Not all doctors agree on who should be screened for PAD. However, it's wise to be tested if any of the following risk factors developed by the American College of Cardiology and the American Heart Association apply to you...

Younger than age 50: If you have diabetes and one additional risk factor (such as smoking or high blood pressure).

Age 50 to 69: If you have a history of smoking or diabetes.

Age 70 and older-even if you have no known risk factors.

Many experts believe that screening also is warranted-regardless of your age-if you have...

Leg symptoms, such as aches and cramping with exertion.

Diagnosis of atherosclerosis, fatty buildup in the walls of the arteries, including those in the heart and neck.

Numbness, tingling or loss of sensation in the feet or cold feet or areas of color change (bluish or dark color, for example) on your toes-an indication of compromised blood flow.

High blood levels of C-reactive protein (CRP), an inflammation marker.

The Test you need

If you meet one of the criteria described above, ask your doctor to test you for PAD. He/she will perform a measurement called an ankle-brachial index to get a sense of whether blood pumps equally through your arms and your legs. To perform this test, your doctor will measure your blood pressure in your ankle as well as in your arm and compare the two numbers.

Best treatment options

There is no medication that will dissolve PAD plaque, so you should work with your doctor to manage your risk factors. If you're a smoker, stopping smoking is the most important step you can take to help control PAD.

Everyone with PAD should...

Get the right kind of exercise. Surprising as it might sound, walking is the most beneficial form of exercise for PAD sufferers. It won't get rid of the plaque, but it can improve your stamina and make walking less painful.

What to do: Walk on flat ground every day-or try a treadmill if you prefer.

Use your level of leg pain to determine the amount of time you walk. For example, walk until the leg pain reaches a moderate level. .. stop walking until the pain is relieved... then resume walking. This approach "trains" the muscle to be more efficient in using its blood supply. Try to work your way up to 50 minutes of walking at least five days a week.

Be sure to consult your doctor before starting a walking program, especially if you have other conditions, such as heart disease, arthritis or spine disease. Supervised exercise, such as that offered at rehab centers, has been shown to be the most effective for PAD patients-perhaps because people are more likely to stick to a walking program in these settings.

Monitor other risk factors. It is critically important to pay attention to all your other health-related risk factors. For example, if you have diabetes, monitor and keep glucose levels under control. If you have elevated cholesterol or high blood pressure, talk with your doctor about medication.

To reduce the risk for blood clots, which could lead to limb damage, heart attack or stroke, your doctor may suggest a daily aspirin (81 mg) or a medication that prevents clotting, such as clopidogrel (Plavix). A statin also may be prescribed. Statins not only lower cholesterol, but also lower levels of the inflammation marker CRP.

When additional treatment is needed

In about 30% of PAD patients, the condition causes severe pain that affects their quality of life or the amount of blockage significantly restricts blood flow. In these cases, your doctor may recommend a more invasive measure, such as angioplasty or bypass surgery, to improve blood flow in the affected artery.

With angioplasty, a tiny balloon and, possibly, stents are inserted via a catheter into the artery to widen the artery as much as possible. Bypass surgery involves creating a blood flow "detour" around a blockage, allowing the blood to flow more freely.

Important: Treatment for PAD is highly individualized. If you've been diagnosed with the condition, you should see your doctor at least once or twice each year.

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