ANNOUNCER: If you are over the age of 50 and have been experiencing severe leg pain while walking or performing daily activities, you may be suffering from a common condition called Peripheral Arterial Disease, or PAD.
DIANE TREAT-JACOBSON, PhD, RN: PAD is a narrowing of the arteries that supply the legs with blood. The arteries can fill up with plaque or calcium and other kinds of things that will narrow the arteries in the legs.
ANNOUNCER: This narrowing of the arteries in the legs leads to inadequate blood flow.
ALAN HIRSCH, MD: Most individuals have heard of the word "hardening of the arteries." The medical term is atherosclerosis. That is derived from the word "athero," which means the gruel or the blockage in the lining of the blood vessel, and sclerosis, which is the deposition of calcium and the hardening of the vessel, and these two processes together can severely narrow and block the artery.
Peripheral arterial disease is caused by the same risk factors that cause blockages in other arteries of the body, such as in the heart and brain. These risk factors include smoking, diabetes, high blood pressure and high blood cholesterol.
This atherosclerotic blockage, by itself, is usually considered to be irreversible, but the rate at which it develops can be markedly blocked by a good, healthy lifestyle and by the use of medications that lower the importance of these risk factors.
ANNOUNCER: But to lower the risk factors of PAD, people must be properly informed about the disease itself.
8-12 million Americans are living with this condition, and up to 8.6 million of these people are without symptoms.
Even those who are symptomatic often mistake the symptoms for something else.
RON GORKE: I’d walk maybe 100 yards and I’d start to get a pain in my buttocks. A kind of a numbness and then it would run down my leg into my calf and I’d have to stop for maybe five minutes and then I could go again. I thought I had a bad hip so I didn’t pay too much attention to it. This went on for about a year and then I decided I better go and get it checked out.
ALAN HIRSCH, MD: I consider peripheral arterial disease to have been a silent epidemic, and silent because of a combination of factors that need to be recognized. It's been silent inasmuch as many patients themselves don't recognize the symptom as being one of a disease that can be altered with medical therapy.
DIANE TREAT-JACOBSON, PhD, RN: Leg pain when you walk is not a normal sign of aging and should be investigated. It can be a sign of a dangerous disease that could lead to a heart attack, a stoke or severe disability.
ALAN HIRSCH, MD: Like other illnesses that block the arteries in the body, peripheral arterial disease is develops slowly over three, five, ten or 20 years. Initially there may be no symptoms whatsoever from the blockage to the leg arteries, although with time, the patient may develop a symptom called claudication. Claudication is a discomfort that is sometimes described as a fatigue, a numbness, a cramping, or may actually be a severe pain that occurs in these muscles with walking and that is relieved when the patient stops to rest. Unfortunately, when the patient begins to walk again, claudication reappears and limits the patient's ability to perform their activities of daily living.
ANNOUNCER: Because PAD symptoms can be confused with symptoms from other conditions such as arthritis or sciatica, it’s important for patients to understand the distinction.
ALAN HIRSCH, MD: One clue that a walking impairment is due to peripheral arterial disease is localization of the discomfort within the muscles of the calves or the thighs, or perhaps the buttocks. In contrast, discomfort that's localized to the knee itself, to the hip joints or the foot is much more likely to represent arthritis or some other medical illness.
For patients with diabetes, many will be familiar with a symptom called neuropathy, which can be burning or painful discomfort of the feet or the thighs. This, too, can sometimes mimic claudication.
At least half, and perhaps as many as 85 to 90% of individuals with PAD of significance may not recognize classical symptoms. Thus, for these individuals who have blockages in their leg arteries, the easiest way for them to establish their PAD diagnosis is by performance of the ankle-brachial index or the ankle blood pressure measurement.
DIANE TREAT-JACOBSON, PhD, RN: “you hear that, that’s your pulse, that’s your heart rate…”
ANNOUNCER: With this simple test, PAD can be detected early and treated appropriately.
And increased awareness of PAD and the ABI test can help prevent the incidence of heart attack, stroke, and even amputation.
Yet many people are still unaware of the prevalence of this disease and its serious consequences.
ALAN HIRSCH, MD: PARTNERS, which stands for "Peripheral Arterial Disease Awareness, Risk and Treatment, New Resources for Survival," was an important 25-city national survey to evaluate the true prevalence of PAD in primary care practices across our country. PARTNERS involved 320 primary care clinics in which patients who were seeing their physician underwent the ankle blood pressure measurement. From PARTNERS we're aware that patients at risk often have PAD, and in fact, of those individuals who are over 70 years of age, over 50 years who either smoked or have diabetes, 29% had evidence of PAD.
PARTNERS has also demonstrated that at least of half of these individuals were not aware of their diagnosis, and few of their physicians were aware of their PAD diagnosis.
PARTNERS therefore also demonstrated that we have a long way to go in establishing accurate diagnoses in doctor's offices and offering effective treatment.
DIANE TREAT-JACOBSON, PhD, RN: You have the disease whether or not you know about it. Knowing about it allows you to do something to prevent it from getting worse and to prevent yourself from having a heart attack or stroke. And making a diagnoses, finding out that you have the disease is a very simple thing to do. It’s a matter of taking the blood pressure in your arms and your legs in the physician's office. It’s a very simple test. It’s painless, it takes about 10 minutes and it’s very inexpensive.
ALAN HIRSCH, MD: Some individuals have considered peripheral arterial disease to be relatively unimportant. I think it's important to recognize that a patient that has PAD faces a six- to sevenfold increased risk of heart attack or stroke. This is as high a risk as faced by a patient who's already had a heart attack or stroke. I cannot think of any other test that so easily defines a high risk group for which treatment can be so effective.
ANNOUNCER: If you think you may be at risk of this condition, talk with your doctor.
Early detection can help prevent future complications and will dramatically improve, and protect, your lifestyle.
For more information on PAD, log on to the Vascular Disease Foundation at www.VDF.org or visit UnderstandingPAD at www.UnderstandingPAD.com