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Though peripheral artery disease (PAD) is a known risk factor for heart disease and stroke, a
new study finds that many patients are not diagnosed with the condition by their
physicians. PAD occurs when arteries in the legs narrow due to hardened plaque build-up on
the walls of the blood vessels. Because many patients do not exhibit the most common
symptom of PAD (leg cramps while exercising), physicians often do not check for PAD.
However, researchers insist that if PAD was more commonly diagnosed, more patients could
take measures to help prevent heart disease and stroke.
Between eight and 12 million Americans have PAD, according to lead researcher Alan
Hirsch, MD of the Minnesota Medical School. Claudication, or pain in the legs, is the main
symptom of PAD, though many patients may not experience claudication or attribute the pain
to other causes, such as aging. In addition to the legs, PAD can occur in the feet,
kidneys, brain, or less commonly in the arms. The risk of PAD increases with age, and it
is estimated that 20% of people over age 70 have the condition. PAD can also occur in
younger people and is more common in those with diabetes, high blood pressure, or high
cholesterol. People who smoke and those who are obese are also more likely to develop PAD.
To conduct their study on PAD, Dr. Hirsch and his colleagues studied 6,979 patients at
350 primary care practices throughout the United States. Participants included those 70
years of age or older and those between the ages of 50 and 69 with a history of cigarette
smoking or diabetes. Patients were asked about their medical history and then given a test
called the ankle-brachial index (ABI), which measures blood pressure in the legs versus
the arms to determine whether PAD is present. If blood pressure in the arms is
significantly higher than in the legs, blood flow in arteries in the legs may be blocked,
suggesting PAD.
After testing the patients, the researchers found that 1,865 patients had PAD. Over
half of the patients with PAD alone were newly diagnosed by Dr. Hirsch and his colleagues.
The researchers also discovered that 1,060 (16%) of the patients had both PAD and heart
disease. Of these patients, 35% were first diagnosed by Dr. Hirsch’s team. These
figures suggest that physicians often do not check for PAD even though it is a risk factor
for heart disease.
According to Dr. Hirsch, if physician go by leg pain alone in deciding which patients
should be tested for PAD, then 85% to 90% of patients with PAD will not be diagnosed with
the condition. Early stages of claudication (leg pain) may be temporary in one or both
legs and may only occur during exercise. Other symptoms of early claudication include
aching, cramping, numbing, or weakness in the legs. As PAD progresses, pain can occur even
at rest due to a severe lack of oxygen in the limbs from narrowed arteries.
Dr. Hirsch and his colleagues say that under-diagnosing PAD leads to a barrier in
preventing heart disease and stroke. In an accompanying editorial published in the Journal
of the American Medical Association, Kenneth Ouriel, MD agreed that PAD is an
important risk factor for atherosclerosis (hardening of the arteries), which can lead to
heart disease. Patients who are diagnosed with PAD should take measures to help treat the
condition. Depending on the patient’s situation, these measures may include increased
exercise (particularly walking), change in diet, antiplatelet drugs (to prevent blood
clotting), or cholesterol-lowering drugs. In some cases, surgery may be necessary.
To help prevent PAD, physicians suggest that patients focus on lowering their risk of
heart disease and stroke. This includes maintaining a healthy diet, exercising,
maintaining healthy cholesterol and blood pressure levels, not smoking, and preventing or
controlling diabetes.
Additional Resources and References
- The study, "Peripheral Arterial Disease Detection, Awareness, and Treatment in
Primary Care," is published in the September 19, 2001 issue of the Journal of the
American Medical Association, http://jama.ama-assn.org/
- The editorial by Kenneth Ouriel, MD, "Detection of Peripheral Arterial Disease in
Primary Care," is published in the September 19, 2001 issue of the Journal of the
American Medical Association, http://jama.ama-assn.org/
- HeartCenterOnline provides information on peripheral artery disease (PAD), http://www.heartcenteronline.com/
- To learn more about heart disease and stroke, please visit http://www.imaginis.com/heart-disease/ and http://www.imaginis.com/stroke/ respectively.
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