What is peripheral arterial disease?
Peripheral arterial disease (PAD), the narrowing of blood vessels in the legs and feet, is a commonly occurring condition in type 2 diabetics who are prone to high cholesterol and heart disease. According to the American Diabetes Association (ADA), “diabetic adults have heart disease-related death rates of two to four times higher than the rate of non-diabetics”. This greater risk of heart attack and stroke is often preceded by symptoms of PAD.
What are the causes of PAD?
In a person with PAD, fatty deposits in the blood vessels restrict the complete flow of blood and oxygen to the legs and feet. That restriction, depending on its severity, can cause pain in the lower legs when walking, and numbness, tingling, and coldness while at rest.
However, the condition is especially troubling in cases when people with PAD have no symptoms at all, because in these situations, PAD can lead to heart attack and stroke without any warning signs.
If you have been diagnosed with PAD, your chances of having a heart attack or stroke would have been vastly increased. According to the Journal of the American Medical Association, “PAD is a powerful predictor of [heart attack], stroke, and death due to vascular causes.”
What are PAD risk factors?
Diabetes increases the risk for PAD by approximately threefold. Many people with PAD may not know it, and while the condition is common, it is also frequently overlooked. You may be at higher risk for PAD if you meet one or more of the following conditions:
- Family history of heart disease;
- High blood pressure;
- High cholesterol;
- Over the age of 40;
- Previous heart attack or strokes;
- Physically inactive;
If you have diabetes, you are much more likely to have PAD, a heart attack, or a stroke. However, you can cut your chances of having those problems by taking special cares of your blood vessels.
What are signs and symptoms of PAD?
Unfortunately, for many people, PAD presents no symptoms.
If symptoms do occur, they may include:
- Leg cramps in the calves brought on by walking or climbing stairs;
- Further symptoms of PAD include:
- Numbness or weakness in the legs;
- Cold in the lower legs;
- Pale or blue tinged legs;
- Infections or sores on the feet or legs;
- Hair loss on the legs or feet;
- Shiny skin;
- In men, erectile dysfunction;
- The muscles in your legs shrinking (wasting);
- Extended healing process(For example, ulcers (open sores) on your feet and legs, which don’t heal).
How do doctors diagnose PAD?
The ankle-brachial index (ABI) is a kind of test used for diagnosing PAD. This test compares the blood pressure in your ankle to the blood pressure in your arm. If the blood pressure in the lower part of your leg is lower than the pressure in your arm, you may have PAD. People with diabetes who are younger than 50 may benefit from testing if they have other PAD risk factors.
These other tests can also be used to diagnosis PAD:
- Angiogram: a test in which dye is injected into the blood vessels using a catheter and X-rays are taken to show whether arteries are narrowed or blocked.
- Ultrasound: a test using sound waves to produce images of the blood vessels on a viewing screen.
- MRI (magnetic resonance imaging): a test using special scanning techniques to detect blockages within blood vessels.
How is PAD treated for diabetics?
People with PAD are at very high risk for heart attacks and stroke, so it is very important to manage cardiovascular risk factors. Here are some steps that you can try:
- Try to quit smoking. Talking with your healthcare provider can offer a tool to help you.
- Aim for an A1C below 7%. The A1C test measures your average blood glucose sugar level over the past 2 to 3 months.
- Lower your blood pressure to less than 140/80 mmHg.
- Get your LDL cholesterol below 100 mg/dl.
- Talk to your healthcare provider about taking aspirin or other antiplatelet medicines. These medicines have been shown to reduce heart attacks and strokes in people with PAD.
Studies have found that physical exercise, such as walking, can be used both to treat PAD and to prevent it. Medications may help relieve symptoms.
In some cases, surgical procedures are used to treat PAD:
- Angioplasty, also called balloon angioplasty: a procedure in which a small tube with a balloon attached is inserted and threaded into an artery; then the balloon is inflated, opening the narrowed artery. A wire tube, called a stent, may be left in place to help keep the artery open.
- Artery bypass graft: a procedure in which a blood vessel is taken from another part of the body and is attached to bypass a blocked artery.
A supervised exercise program or cilostazol are the preferred first treatment steps for the management of symptomatic PAD. Moreover, it can help you to prevent ischemic events with aggressive antiplatelet therapy such as clopidogrel as well.
Hello Health Group does not provide medical advice, diagnosis or treatment.
Review Date: February 5, 2017 | Last Modified: January 23, 2017
A.D.A.M. Medical Encyclopedia. (2011) Peripheral Artery Disease – Legs.http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001223/. Accessed January 23, 2017.
American Diabetes Association. (2011) Peripheral Arterial Disease (PAD). http://www.diabetes.org/living-with-diabetes/complications/heart-disease/peripheral-arterial-disease.html. Accessed January 23, 2017.
Daniela C. Gey, M.D. et al. (2004) Management of Peripheral Arterial Disease. American Family Physician, 69 (3): 525–532. http://www.aafp.org/afp/2004/0201/p525.html. Accessed January 23, 2017.
Lower extremity arterial disease in elderly subjects with systolic hypertension. (1991).Journal of Clinical Epidemiology, 44, pp. 15-20.
Peripheral Arterial Disease (PAD) Fact Sheet. (n.d.) Centers for Disease Control and Prevention. Retrieved June 8, 2014, from http://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_pad.htm. Accessed January 23, 2017.