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Earlier Detection of Artery Disease Needed

June 10, 2008 - 7:30am
 
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Earlier Detection of Artery Disease Needed

Doctor measuring man's blood pressure When we think of cardiovascular health, we think about our hearts. Blood vessels are a critical part but get much less attention. But atherosclerosis, hardening of the arteries, is blind when it comes to the cardiovascular system. It strikes with equal ferocity in arteries in the heart or in the legs.

Research now indicates that peripheral artery disease (PAD) has largely been unrecognized or ignored. It is often mistakenly thought to be a normal part of the aging process. The good news is that increased use of a simple test could improve detection of this deadly disorder.

Dangers of Peripheral Artery Disease

PAD occurs when atherosclerosis results in a buildup of plaques in the arteries of the legs. Atherosclerosis can affect the entire cardiovascular system. As a result, patients with PAD have a risk of heart attack or stroke that is five to seven times greater than the general population. It is about the same risk as someone who has heart disease.

People with arterial plaque in their extremities can also develop life-threatening problems such as ulcers or gangrene. These developments are rare but serious. More than one-third of patients with these complications eventually have a limb amputation.

Who Is at Risk for PAD?

Many people are not aware of the dangers of clogged arteries in the legs. According to a recent survey by the National Coalition on Aging, only 32% of people 50 and older are familiar with PAD. Yet the condition is very common, affecting up to 12 million people in the US.

Of those afflicted with PAD, about twice as many are men than are women. The condition increases with age in the general population as follows:

Age (years)Proportion affected (%)
40-592.5
60-698.3
70-7918.8

The other risk factors for PAD are similar to those that increase your chances of getting heart disease. These may include:

Symptoms and Signs of PAD

So how do you know if you have PAD? The problem is that atherosclerosis is a very gradual process. Early in the disease most people don't have any symptoms. Even later on, only about one-third have classic symptoms of PAD.

The condition's earliest and most characteristic symptom is pain in the calves or thighs while walking. This is called intermittent claudication. This usually occurs after walking a certain distance and ends after resting for a consistent length of time. Other symptoms may include:

  • Numbness, weakness, or a feeling of heaviness in the legs
  • Burning or aching in the feet at rest, especially while lying flat
  • Coolness or color changes of the legs or feet
  • Foot sores that are slow to heal

Diagnosis and Early Detection

Since the symptoms of PAD are often absent or unrecognized, many people who have the disease don't know it. A recent study found that a simple, non-invasive blood pressure test can be done in the doctor's office to detect PAD.

The test is called the ankle-brachial index, or ABI. It involves taking pressures in both arms and ankles using a blood pressure cuff and a simple device to detect blood flow called a Doppler. The resulting blood pressure readings are then used to calculate your ABI. A value less than or equal to 0.9 signals PAD.

Researchers in the study who used the ABI test detected PAD in 29% of 7,000 subjects over the age of 49 at risk for the disorder. Over half of these patients had never before been diagnosed with the condition. Of those previously diagnosed with PAD, the patient's current doctor didn't know about it in roughly half the cases. The researchers concluded that PAD is an under-diagnosed condition. Increased use of the ABI test could improve detection.

Who Should Be Screened for PAD?

It remains unclear whether patients who are screened for PAD with an ABI or other test are less likely to have future major complications. Nevertheless, early detection of PAD, particular if the screening test is safe and accurate. It could, theoretically, improve your chances of a favorable outcome. Medications and other interventions are available to treat atherosclerosis and reduce some of the complications associated with PAD.

More conclusive evidence, however, suggests that screening for and treating PAD risk factors, particularly high blood pressure, abnormal cholesterol, obesity, and smoking, can improve your risk of cardiovascular disease in general. So whether or not you and your doctor decide to take a presymptomatic look for PAD, focus your efforts on reducing your overall risk of cardiovascular disease.

RESOURCES

Vascular Disease Foundation
http://www.vdf.org/

American Heart Association
http://www.americanheart.org/

Society of Cardiovascular and Interventional Radiology
http://www.scvir.org/

The National Council on Aging
http://www.ncoa.org/

CANADIAN RESOURCES:

Canadian Cardiovascular Society
http://www.ccs.ca/home/index_e.aspx

Heart and Stroke Foundation of Canada
http://ww2.heartandstroke.ca/Page.asp?PageID=24

References

Hirsch A, Criqui M, Treat-Jacobson D. Peripheral arterial disease detection, awareness, and treatment in primary care. JAMA. 2001;286:1317-1324.

Ouriel K. Detection of peripheral arterial disease in primary care. JAMA. 2001;286:1380-1381.

Peripheral arterial disease. JAMA. 2001;286:1406.

Chronic arterial insufficiency of the lower extremities: the latest AHA guidelines for diagnosis and treatment. Consultant. 1997;1081-1084.



Last reviewed March 2008 by Michael J. Fucci, DO

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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