The Doctors are in: Peripheral arterial disease, a silent but serious health threat

The Doctors are in: Peripheral arterial disease, a silent but serious health threat

Peripheral arterial disease, or PAD, is a rather common disease process affecting well over 12 million Americans.

But it is a serious disease; even when completely silent and asymptomatic, it carries a risk of death much higher than most cancers.

What is PAD?

It is a progressive process of plaque buildup within the vessel wall leading to gradually worsening degrees of narrowing and ultimate occlusion of many vessels and arteries in the body.

The net result is a reduction of blood flow to various parts of the body with its inherent negative consequences. Most medical providers specifically concentrate on the blockages in the blood vessels to the legs when talking about PAD, yet the process is fairly diffuse, affecting the vessels of the legs, the heart, the brain and many other vital organs.

What are the signs or symptoms?

It is not uncommon for the disease to go on for years without symptoms. When symptoms begin, patients typically have leg discomfort ? most often in the calves ? while walking that resolves with rest. In more severe cases, the discomfort could be near constant in the feet and not resolve with rest. In yet more advanced cases, patients develop ulcerations and wounds that fail to heal and that can lead to amputation.

How do I prevent PAD?

The risk factors for PAD are much the same as what most of us think are risk factors for heart disease: diabetes, smoking, high blood pressure, obesity and high cholesterol. Genetic factors (a family history of cardiovascular disease at young age) and dietary factors and lack of exercise, also could increase the risk of PAD.

Preventive measures are very effective, and the earlier we implement them, the better they work. The only irreversible factor is genetic predisposition, yet aggressive reduction of other risk factors in an individual with "bad genes" helps reduce disease development, or delay the disease process. For example, someone whose ancestors had PAD at 50 could delay onset of PAD, if not prevent it altogether, to the 60s and sometimes 70s.

Of all the risk factors, smoking is one of the strongest. But medical research has shown that most smokers have an average duration of less than 90 seconds for their cravings. So if a smoker holds off lighting up for 90 seconds, the urge will be gone. Knowing this simple fact has helped many of my patients quit completely, or at least cut down their cigarette usage.

To help fight PAD, people should know their "bad cholesterol" (LDL) and "good cholesterol" (HDL) numbers, preferably by the age of 30; be screened for high blood pressure and diabetes; and address their weight, diet and lifestyle choices with their doctors.

What to do when diagnosed with PAD

The good news is that PAD and its risk factors are indeed treatable. Yet treatment takes a real team effort, in which the patient must become an active participant.

The blessing in disguise

A PAD diagnosis is easy (it only takes feeling the pulse in the feet and finding it to be diminished or absent). That simple discovery should prompt a much more thorough evaluation of the patient's cardiovascular system. Many times when such an evaluation is performed, severe blockages in the heart or brain vessels are discovered and corrected, thus aborting a sure stroke or heart attack.

Yet too many patients leave their doctor's offices without having their pulses checked in their feet. Please, for your own health ... take off your shoes.

Yazan Khatib is one of the founding partners of First Coast Cardiovascular Institute, the director of Limb Salvage/Endovascular Interventions and co-founder of the Save a Leg Save a Life foundation.

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