University of Virginia Health System

Leg Artery Disease Boosts Heart Risk

Three-quarters of adult Americans polled recently said they knew little or nothing about peripheral arterial disease (PAD), a very common blockage of blood vessels in the legs that boosts the risk of heart attack and stroke.

"Most of us know that many of the patients at risk don't seek medical attention," says Murphy. "But it was surprising that the knowledge base was as small as it was, considering that there are 8 million people in the U.S. with the disease."

Fatty Deposits Cause Blockage

In PAD, arteries in the legs are narrowed or blocked with fatty deposits. These obstructions can cause leg pain but often produces no other symptoms.

PAD can damage legs enough to require amputation, and it can also signal a raised risk of heart attacks or strokes caused by a narrowing of the arteries elsewhere in the body.

Three-quarters of the 2,051 people ages 50 and older surveyed said they were aware of strokes, and two-thirds knew about risks of coronary artery disease and heart failure.

But just 25 percent knew about PAD - far behind awareness levels for much rarer conditions, such as Lou Gehrig's disease (36 percent) and multiple sclerosis (42 percent).

Among the one in four adults who were aware of PAD, only 28 percent associated it with an increased risk of heart attack, and just 14 percent linked it with amputation and death.

That is no big surprise, says Murphy, since "the link between PAD and heart attacks and stroke is just becoming disseminated among primary-care physicians."

Relatively few family physicians routinely perform the basic diagnostic test for PAD, called the ankle-brachial index, he says.

Blood pressure is measured in the arm and the ankle, with the measurements repeated at both sites after five minutes of walking on a treadmill.

Lower pressure at the ankle indicates PAD. The lower the ankle-brachial index, the greater the danger.

"The test is not often done in a primary-care physician's office," explains Murphy. "It is not reimbursed under Medicare unless there are symptoms, and it is hard to ask physicians to do a test unless they are reimbursed. We are trying to get support for Medicare to reimburse for it as a diagnostic test."

Pain Symptoms Sometimes Go Unheeded

Diagnosis of PAD indicates the need for attention to the well-known risk factors for arterial blockage elsewhere in the body, such as smoking, high blood pressure, cholesterol levels and lack of exercise, says report author Dr. Alan T. Hirsch of the University of Minnesota.

Lack of awareness means that even adults who have leg pains or other symptoms of PAD are not aware of its dangers, notes Hirsch. "At a time when the public is bombarded with health messages, it would seem wise for those with one of the single most common cardiovascular diseases to be aware of the risk," he says.

The survey also shows that physicians are not doing enough to raise awareness of the risk from PAD risk, Hirsch adds.

While 26 percent of those in the survey who were aware of PAD said they got information from broadcast media such as television, only 19 percent reported first hearing about PAD from a healthcare provider.

Physicians should be aware of PAD symptoms as a major warning sign of potential trouble, says Hirsch. "Denigrating leg pain as unimportant is as logical as avoiding chest pain."

There are some symptoms of PAD that you can watch for, says Nancy Harthun, M.D., an Associate Professor of Surgery at the University of Virginia Health System who specializes in treating patients with PAD.

"The first symptom is called claudication, a discomfort that arises in leg muscles during exertion, such as walking a long distance or walking up hills or steps. This discomfort is relieved soon after the exertion is stopped," she says. "Later symptoms can involve unremitting, severe pain in the feet or toes. During the later stages of this disease, skin injuries may not heal or skin ulcers may develop spontaneously."

Anyone with any of those symptoms should be evaluated for PAD by their doctor, Harthun says. She adds that people older than 40 with one or more of the following risk factors may want to be screened for PAD:

• History of smoking
• Diabetes
• Family history of PAD
• High cholesterol
• High blood pressure

The Peripheral Arterial Disease Coalition, which conducted the survey, is funded by grants from the Bristol-Myers Squibb/Sanofi Aventis Partnership (both partnership members are drug companies) and medical device maker Cordis Endovascular, a division of Cordis Corp.

To learn more about PAD and other health topics, visit www.uvahealth.com. 

Always consult your physician for more information.