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PAD & Diabetes: Making the Connection

PAD & Diabetes: Making the Connection

According to recent estimates, more than 15 million Americans have peripheral arterial disease (PAD), a disease characterized by atherosclerotic occlusive disease of the lower extremities. “About 20% to 25% of patients with diabetes who are older than 50 has PAD,” says Peter Sheehan, MD. “Estimates are even higher in the Medicare population with diabetes. About 30% of diabetics aged 65 and older have PAD.” Of those with PAD, more than half are asymptomatic or have atypical symptoms, about one-third have claudication, and the remainder have more severe forms of the disease. Cardiovascular event rates in patients with PAD and diabetes are higher than those of their non-diabetic counterparts. Research has shown that PAD is a major risk factor for lower-extremity amputation, and it is also accompanied by a high likelihood for symptomatic cardiovascular and cerebrovascular disease. “Even for asymptomatic patients, PAD is a marker for systemic vascular disease involving coronary, cerebral, and renal vessels,” Dr. Sheehan says. “This increases the risk of myocardial infarction, stroke, and death.” He adds that diabetes and smoking are strong risk factors for PAD. Other well-known risk factors are advanced age, hypertension, and hyperlipidemia. Making the Diagnosis Diagnosing PAD is of clinical importance because it helps identify patients at high risk of heart attack or stroke, regardless of whether symptoms of PAD are present, and because it enables clinicians to elicit and treat symptoms. “Each patient with diabetes who has PAD will have varying symptoms and atherosclerotic disease,” says Dr. Sheehan. Accordingly, the American Diabetes Association recommends that patients have their feet checked regularly to assess for signs of foot complications and possible PAD...
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