Peripheral artery disease and its prevention
Peripheral artery disease (PAD) is a condition, in which a plaque builds up in arteries that supply blood to the head, organs or limbs. When a plaque builds up in an artery, it is called atherosclerosis.
Peripheral artery disease usually refers to development of atherosclerosis of the arteries of the legs, thus blocking blood flow to them. Blocked blood flow to the legs can cause pain and numbness. It also can raise the risk of getting an infection in the affected limbs. The body may have a hard time fighting the infection.
PDA has an age-adjusted prevalence of approximately 12%. The following figure shows the prevalence of peripheral artery disease by age in men and women -
Causes – The common causes are as follows -
- High amount of fats and cholesterol and fat in the blood
- High blood pressure
- Insulin resistance or diabetes
- Less commonly, blood vessel inflammation, injury to the limbs, unusual anatomy of the ligaments or muscles, or radiation exposure
Symptoms and signs – The common signs and symptoms are as follows -
- Leg pain that does not go away when you stop exercising or walking
- Foot or toe wounds that won't heal or heal very slowly
- Gangrene (tissue death)
- A marked decrease in the temperature of the lower leg or foot particularly compared to the other leg or to the rest of your body
- A change in the color of the legs
- No pulse or weak pulse in the feet and legs
- Slower growths of toenails
- Erectile dysfunction in men
Risk factors – The common risk factors are as follows –
- Physical inactivity
- High blood pressure (140/90 millimeters of Hg or higher)
- High cholesterol (total blood cholesterol over 240 milligrams per deciliter)
- Increasing age, especially after reaching 50 years of age
- A family history of peripheral artery disease, heart disease or stroke
- High levels of homocysteine, a protein component that helps build and maintain tissue
Complications – The common complications of PAD are as follows –
- Limb ischemia- This condition begins as open sores that don't heal, an injury, or an infection of the feet or legs. Critical limb ischemia occurs when such injuries or infections progress and can cause tissue death (gangrene), sometimes requiring amputation of the affected limb.
- Stroke and heart attack- The atherosclerosis that causes the signs and symptoms of peripheral artery disease isn't limited to the legs. Fat deposits also build up in arteries supplying the heart and brain.
Management by lifestyle changes –
Smoking cessation – Smoking progresses the disease and increases the rest pain and chances of amputation. So, smoking cessation reduces the symptoms of the disease. In addition, it also helps prevent heart attacks and strokes.
Regular exercise - The most effective treatment for PAD is regular physical activity but begin slowly. Take into account that walking causes pain. Therefore, the program consists of alternating activity and rest in intervals to build up the amount of time a person can walk before the pain sets in.
Diet - Many PAD patients have elevated cholesterol. A diet low in saturated fat, trans fat and cholesterol can help lower cholesterol level, but cholesterol lowerings drugs may be necessary to maintain the proper cholesterol levels.
Management of diabetes – Aggressive management of diabetes will limit the mortality and morbidity of persons having PAD. But the aggressive management of diabetes does not improve claudication symptoms. On the other hand, such a strategy will reduce the rate of cardiovascular events and micro-vascular complications (e.g., retinopathy, neuropathy).Therefore, strict diabetes control is advocated for this population.
Dyslipidemia management – Hyperlipidemia is associated with many PDA patients. Lipid lowering therapy reduces the risk of new or worsening symptoms of intermittent claudication.
Hypertension treatment - The target blood pressure in hypertensive PAD patients is similar to that for patients who have coronary artery disease.Special attention should be directed to hypertensive PAD patients who are also diabetic.
Weight loss – Weight loss should be done achieving the target BMI 18.5 to 24.9 kg/square m.
PAD is a condition that can lead to a serious complication of the development of gangrene, so the disease should be managed properly. Moreover, it can be associated with hypertension and diabetes, in which case its management requires more attention and caution.
This disease can be effectively controlled by lifestyle changes such as cessation of smoking, regular exercise, diet, aggressive management of diabetes, management of hyperlipidemia, hypertension treatment and weight loss.