When Arteries Harden

By L.A. McKeown
WebMD Feature

Sept. 3, 2001 -- A few years ago, a doctor in New York City went to a free screening test aimed at detecting artery disease in the legs. To his surprise, he had fairly serious disease and was fortunate to be able to receive treatment that may have saved him from having a heart attack or stroke, or even from needing to have his legs amputated.

Peter Beatty, MD, tells the story to show people that if a doctor didn't know he had fairly advanced peripheral arterial disease, or PAD, chances are pretty good you probably wouldn't know if you had it either.

PAD affects more than 10 million Americans, most of whom are over age 50. A common and potentially deadly disease, PAD occurs when blood flow to the arteries of the legs is blocked -- commonly known as "hardening of the arteries." The risk of heart attacks and strokes may be as much as eight or nine times higher if you have PAD.

Symptoms include pain, cramping, or swelling of the legs, difficulty walking, numbness, and skin discoloration. But many people, including doctors, sometimes mistake it for arthritis or other non-life-threatening conditions.

"Most people think it's just part of the aging process, and they usually don't seek attention until very late in the course of the disease," says Karl Chiang, MD.

Late signs of PAD can include your toes turning black or ulcers that don't heal developing on the foot or leg. Left untreated, the foot or leg may have to be amputated.

Who's at Risk for PAD?

Although anyone can be at risk, factors that can significantly increase your risk of PAD include:

smoking;
having high blood pressure, diabetes, or high cholesterol;
having a family history of heart or blood vessel disease;
being overweight.

Smokers and diabetics between the ages of 50 and 60, or people over age 70, have a one-in-three chance of developing PAD, according to a recent study.

Many people with PAD can barely walk, while others may have mild symptoms that are easily overlooked.

"People are aware of diseases like heart attacks and strokes, which are caused by the same disease process that causes ... hardening of the arteries," says Chiang. "I don't think people realize that it's important that blood vessels in the legs are taken care of in a preventative sense as well as treated early on. Most people wouldn't wait to get their heart attack or stroke treated, but they wait to get their legs [looked at] and treated."

Get a Leg Up on Screening

The only way to find out if you have PAD or are at risk for it is to undergo a simple screening test. Chiang, a vascular radiologist at Brody School of Medicine at East Carolina University, in Greenville, N.C., is an enthusiastic supporter of screening for PAD.

He is one of many who will volunteer their time this month to provide free screenings for PAD, just like the one attended by the New York City doctor who didn't realize he had an artery problem. The screenings will be held around the country during the week of Sept. 15-21 as part of the Legs for Life Program sponsored by the Society of Cardiovascular and Interventional Radiology.

The program has been in existence nationwide since 1997, says Peter Beatty, MD, chairman of the event. Last year nearly 60,000 people received the free screening, and one in four people screened was found to be at risk for PAD. The screening involves comparing blood pressure readings from your ankles with blood pressure readings in your arms and takes about 15-20 minutes.

People who attend a screening meet with a doctor following the blood pressure readings, and if an abnormality is found, a copy of the results is sent to their doctor.

"If we can get to people early -- before their leg hurts -- maybe we can prevent them from having a heart attack or stroke," Beatty says.

To locate a Legs for Life screening site in your area or request a free educational brochure about PAD, go to www.legsforlife.org or call toll-free (877) 357-2847.

Many Treatment Options Exist

Various treatments are available for PAD depending on the severity of the disease. In mild cases your doctor may suggest doing nothing and conducting periodic screening to see if the disease is progressing. Lifestyle changes may be necessary, including eating a healthier diet, quitting smoking, and getting more exercise.

Medications such as anti-blood-clotting drugs are another option, says Beatty, MD, a vascular radiologist in private practice in Portland, Ore. Other medications that may be prescribed, depending on the individual needs of the patient, are drugs that lower high blood pressure and drugs that lower high cholesterol.

In cases of more severe disease, "keyhole" surgery may be necessary to improve blood flow. This type of treatment involves using a tiny balloon device to widen the artery -- a process called an angioplasty -- or inserting a metal cylinder called a stent to hold a closed artery open. In more severe cases, bypass surgery may be necessary to create a detour around the blocked artery.

For some people, though, improving PAD may be as simple as putting one foot in front of the other.

"I tell many people, if you walk half an hour a day vigorously, you will in six months improve as much as if I did a bypass or an angioplasty or treated you with medication," says Alan Koslow, MD, senior vascular surgeon at the Iowa Heart Center Vascular Disease Institute.

Raising Public Awareness

Screening programs like Legs for Life are necessary because it appears many doctors are not screening their patients for PAD, as evidenced by the results of a recent survey.

The National Council on the Aging reports that more than 50% of people with symptoms commonly associated with PAD are not being tested. What's more, about two-thirds of Americans over age 50 aren't aware of the dangers of PAD and the need to get tested.

The survey of 1,500 Americans also found that people appear to be far less concerned about PAD than about other diseases. Only 34% said they were "very or somewhat concerned" about developing PAD compared with 58% and 57% who were "very or somewhat concerned" about stroke and heart disease, respectively.

Beatty hopes with enough public education aimed at patients and doctors, more people will be diagnosed early when there is the best chance of improving both the quality and length of their life.

"There are 100,000 [leg and foot] amputations done in the United States each year for peripheral vascular disease," he says. "While people may be most worried about having a heart attack or a stroke, losing a leg or having a gangrenous foot isn't much fun either."

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