Peripheral artery disease (PAD) is a clinical manifestation of atherosclerosis, which occurs when atherosclerotic plaque narrows arteries and decreases blood flow to the legs. An estimated 8 to 10 million people have PAD, and the disease is most prevalent in older persons. Individuals with atherosclerotic risk factors are at increased risk for PAD. Two of the cardinal risk factors are cigarette smoking and diabetes; patients who either smoke or have diabetes are two to four times more likely to develop PAD than others.  As atherosclerosis is a systemic disorder, patients with PAD are at increased risk of having coronary artery disease and cerebrovascular disease, and consequently myocardial infarction, stroke, and cardiovascular death. Risk factor modification and antiplatelet therapy are indicated to prevent these adverse cardiovascular events.

About 10% of people with diabetes older than 40 have PAD, but many who show warning signs don’t realize that they have it and will not get treated for it. The most characteristic symptom is intermittent claudication, variably described as an ache, cramp pain, or fatigue in the calf, thigh, or even buttocks, that develops while walking and resolves with rest, among others.  Severe PAD may cause foot pain at rest, and result in skin ulceration or gangrene. If PAD is not detected, then appropriate therapies to reduce the risk of cardiovascular events, improve leg symptoms, and prevent limb loss may not be instituted in a timely manner.

Screening is Paramount

According to current American College of Cardiology/American Heart Association guidelines, screening for PAD is recommended for all patients with diabetes older than 50, people older than 50 who smoke, and everyone older than 70. The ankle brachial index is one recommended tool for screening the disease early. People with diabetes who are younger than 50 may also benefit from screening if they have other PAD risk factors. The principal mission of one organization, the PAD Coalition (http://www.padcoalition.org), is to increase awareness of PAD among the public and physicians. Raising awareness about PAD will hopefully mean that opportunities for diagnosis and treatment are not missed.

Resources Are Available

The PAD Coalition and its parent organization, the Vascular Disease Foundation, offer a number of resources for physicians, including tools to make patients more aware of the potential problems of PAD and strategies for diagnostics and treatment. The PAD Coalition also produces a number of important physician resources, such as reference summaries of national PAD management guidelines, a slide library, and an exercise-training toolkit. The exercise-training toolkit is particularly important because exercise—together with proper management of diabetes, blood pressure, and cholesterol—is a key treatment strategy for the disease.  The Coalition also has materials to help physicians, institutions, and hospitals host PAD screening programs in the community.

In addition to these tools, the PAD Coalition provides an interactive workbook for patients to teach them about managing the disease (http://www.myPADguide.org) as well as a book on 100 frequently asked questions and answers on PAD.   Patients with vascular disease can register to receive the Vascular Disease Foundation’s free Keeping in Circulation magazine (http://www.vdf.org/keeping-in-circulation), featuring the latest information and tips for managing and coping with vascular diseases.

Research Efforts Continue

Through organizations like the Vascular Disease Foundation and its PAD Coalition, awareness of the problem of PAD has increased substantially, but there is more work to be done. There is currently a significant treatment gap in PAD that is being addressed with ongoing research. Numerous clinical trials are underway to find effective therapies. In addition, more attention is being paid toward interventional therapies, such as angioplasty and stenting, to improve symptoms. The hope is that this research will arm physicians with more effective therapies to improve quality of life and symptoms and to reduce the risk of cardiovascular outcomes in this patient group. Ultimately, the goal will be to decrease risks over losing life or limb.

References

PAD Coalition. Available at: www.padcoalition.org.

Olin JW, Sealove BA. Peripheral artery disease: current insight into the disease and its diagnosis and management. Mayo Clin Proc. 2010;85:678-692.

Alzamora MT, Forés R, Baena-Díez JM,et al. The peripheral arterial disease study (PERART/ARTPER): prevalence and risk factors in the general population. BMC Public Health. 2010;10:38. Available at: www.ncbi.nlm.nih.gov/pmc/articles/PMC2835682.

Moussa ID, Jaff MR, Mehran R, et al. Prevalence and prediction of previously unrecognized peripheral arterial disease in patients with coronary artery disease: the Peripheral Arterial Disease in Interventional Patients Study. Catheter Cardiovasc Interv. 2009;73:719-724.

Mukherjee D. Peripheral and cerebrovascular atherosclerotic disease in diabetes mellitus. Best Pract Res Clin Endocrinol Metab. 2009;23:335-345.