Peripheral Arterial Disease

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PAD

NIH - What Is Peripheral Arterial Disease? “Peripheral arterial disease (PAD) occurs when a fatty material called plaque (plak) builds up on the inside walls of the arteries that carry blood from the heart to the head, internal organs, and limbs. PAD is also known as atherosclerotic peripheral arterial disease. The buildup of plaque on the artery walls is called atherosclerosis (ath-er-o-skler-O-sis), or hardening of the arteries. Atherosclerosis causes the arteries to narrow or become blocked, which can reduce or block blood flow. PAD most commonly affects blood flow to the legs. Blocked blood flow can cause pain and numbness. It also can increase a person's chance of getting an infection, and it can make it difficult for the person's body to fight the infection. If severe enough, blocked blood flow can cause tissue death (gangrene). PAD is the leading cause of leg amputation. … A person with PAD has a six to seven times greater risk of CAD, heart attack, stroke, or transient ischemic attack ("mini stroke") than the rest of the population. If a person has heart disease, he or she has a 1 in 3 chance of having blocked arteries in the legs. Early diagnosis and treatment of PAD, including screening high-risk individuals, are important to prevent disability and save lives. PAD treatment may stop the disease from progressing and reduce the risk of heart attack, heart disease, and stroke. Although PAD is serious, it is treatable. The buildup of plaque in the arteries can often be stopped or reversed with dietary changes, exercise, and efforts to lower high cholesterol levels and high blood pressure. In some patients, blood flow in the vessels may be improved by medicines or surgery. “

NIH - Arteriosclerosis of the extremities "Arteriosclerosis of the extremities is a disease of the blood vessels characterized by narrowing and hardening of the arteries that supply the legs and feet. This causes a decrease in blood flow that can injure nerves and other tissues. Arteriosclerosis, or "hardening of the arteries," commonly shows its effects first in the legs and feet. The narrowing of the arteries may progress to total closure (occlusion) of the vessel. The vessel walls become less elastic and cannot dilate to allow greater blood flow when needed (such as during exercise). Calcium deposits in the walls of the arteries contribute to the narrowing and stiffness. The effects of these deposits may be seen on ordinary X-rays. This is a common disorder, usually affecting men over age 50. People are at higher risk if they have a personal or family history of: Diabetes Heart disease (coronary artery disease) High blood pressure (hypertension) Kidney disease involving hemodialysis Smoking Stroke (cerebrovascular disease) Symptoms Return to top Often, symptoms affect one limb. If arteriosclerosis is in both limbs, the intensity is usually different in each. Change of color of the legs Cold legs or feet Leg pain (intermittent claudication) Occurs with exercise (such as walking) Relieved with rest Loss of hair on the legs and/or feet Muscle pain in the thighs, calves, or feet Numbness of the legs or feet at rest Paleness or blueness (cyanosis) Walking/gait abnormalities Weak or absent pulse in the limb"

Highlighted Articles

Association between ankle - brachial index and risk factor profile in patients newly diagnosed with intermittent claudication. (Circ J. 2008) “Peripheral arterial disease (PAD) affects up to 20% of adults older than 55 years and is associated with silent or symptomatic arterial disease in other vascular beds.1–3 Although the majority of PAD patients are asymptomatic with a low rate of local symptoms and complications, both symptomatic and asymptomatic PAD patients carry a higher risk for vascular events. PAD is considered as a coronary heart disease (CHD) equivalent and is characterized by high mortality rates (approximately 25–30% within 5 years for patients with symptomatic PAD), mainly from stroke and myocardial infarction.”

Peripheral Arterial Disease -- A Cardiovascular Time Bomb (Br J Diabetes Vasc Dis. 2007) “People with PAD are six times more likely to die from cardiovascular disease within 10 years than people without PAD. Evidence suggests that aggressive risk factor management will prevent many premature deaths and associated morbidity. Therefore, it is vital to identify patients and initiate effective management strategies swiftly. However, whilst 40% of PAD patients have symptomatic disease ranging from intermittent claudication to critical limb ischaemia, around 60% are asymptomatic. As a result of the low rates of detection PAD is underdiagnosed and undertreated in the UK.”

Medical treatment of peripheral arterial disease. "CONTEXT: Peripheral arterial disease (PAD) affects approximately 20% of adults older than 55 years and is a powerful predictor of myocardial infarction, stroke, and death due to vascular causes. The goals of treatment are to prevent future major coronary and cerebrovascular events and improve leg symptoms. … CONCLUSION: The substantial and increasing burden of PAD, and its local and systemic complications, can be reduced by lifestyle modification (smoking cessation, exercise) and medical therapies (nicotine replacement therapy, bupropion, antihypertensive drugs, statins, and antiplatelet drugs)."

Internet Site

NIH - Peripheral Arterial Disease

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Peripheral Arterial Disease

General Information

NEWS:

High Peripheral Artery Disease Prevalence in Blacks Still Unexplained

ARTICLES:

JOURNAL ARTICLES:

Chronic Helicobacter pylori infection is associated with peripheral arterial disease. (J Infect Chemother. 2008) “Our results suggest that chronic H. pylori infection may be one of the risk factors for PAD.”

Depressive symptoms in peripheral arterial disease: A follow-up study on prevalence, stability, and risk factors. (J Affect Disord. 2008)

Determinants of Endothelial Function in a Cohort of Patients with Peripheral Artery Disease. (Cardiology. 2008) “Conclusions: Our findings suggest that metabolic syndrome is an important determinant of endothelial function in patients with PAD, and OPG may be a useful biomarker of this effect.”

Long-term prognosis of patients with peripheral arterial disease: a comparison in patients with coronary artery disease. (J Am Coll Cardiol. 2008) “CONCLUSIONS: Long-term prognosis of vascular surgery patients is significantly worse than for patients with CAD. The vascular surgery patients receive less cardiac medication than CAD patients do, and cerebro-cardiovascular events are the major cause of late death.”

Nutrition impacts the prevalence of peripheral arterial disease in the United States. (J Vasc Surg. 2008) “CONCLUSIONS: Improved nutrition is associated with a reduced prevalence of PAD in the US population. Higher consumption of specific nutrients, including antioxidants (vitamin A, C, and E), vitamin B(6), fiber, folate, and omega-3 fatty acids have a significant protective effect, irrespective of traditional cardiovascular risk factors. These findings suggest specific dietary supplementation may afford additional protection, above traditional risk factor modification, for the prevention of PAD.”

Peripheral arterial disease and its clinical significance in nonagenarians. (Aging Clin Exp Res. 2008)

Peripheral arterial disease alters heart rate variability in cardiovascular patients. (Pacing Clin Electrophysiol. 2008)

[Peripheral arterial disease: predictors and treatment. Based on the two-year data of the INVADE study] (Dtsch Med Wochenschr. 2008) “RESULTS: The prevalence of PDA was 18.6%. In 75% of the PAD patients the diagnosis had been unknown before study onset. Those with PAD were significant younger (69.6 vs. 72.2 years; p<0.0001), had significant lower hsCRP values (3,8 mg/l vs. 4.9 mg/l; p=0.002) and a lower vascular risk profile. After two years of intervention an improvement of vascular risk factors and reduction in necessary treatment, such as antihypertensives and platelet inhibitors, was documented. Independent risk factors for PAD development, in addition to the baseline ABI, were age, years of smoking (packs per day) and hsCRP. CONCLUSION: The INVADE project confirms the high prevalence of PAD in an elderly population. These data underline the importance of measuring hsCRP for diagnosing and following PAD development.”

Peripheral Arterial Disease -- A Cardiovascular Time Bomb (Br J Diabetes Vasc Dis. 2007) “People with PAD are six times more likely to die from cardiovascular disease within 10 years than people without PAD. Evidence suggests that aggressive risk factor management will prevent many premature deaths and associated morbidity. Therefore, it is vital to identify patients and initiate effective management strategies swiftly. However, whilst 40% of PAD patients have symptomatic disease ranging from intermittent claudication to critical limb ischaemia, around 60% are asymptomatic. As a result of the low rates of detection PAD is underdiagnosed and undertreated in the UK.”

Physical activity is a predictor of all-cause mortality in patients with intermittent claudication (Journal of Vascular Surgery 2008) “Patients limited by intermittent claudication who engage in any amount of weekly physical activity beyond light intensity at baseline have a lower mortality rate than their sedentary counterparts who perform either no physical activity or only light-intensity activities. The protective effect of physical activity persists even after adjusting for other predictors of mortality, which include age, ABI, and BMI. “

Prevalence and Risk Factors of PAD among Patients with Elevated ABI (European Journal of Vascular and Endovascular Surgery 2008) “The prevalence of elevated ABI in patients referred to vascular consultation is 8.4% and that of PAD among these 62.2%. PAD is significantly more probable among those with chronic renal failure, a history of smoking and coronary heart disease. Furthermore, the specificity of elevated ABI (=1.3) in recognizing PAD is good, whereas the sensitivity is only satisfactory.“

Prevalence of peripheral arterial disease in patients with diabetes mellitus in a primary care setting. (Med J Malaysia. 2007) “The overall prevalence of PAD was 16% in this diabetic population. The prevalence of PAD was 5.8% in Malays, 19.4% in Chinese and 19.8% in Indians. The prevalence of peripheral neuropathy was 41%, foot ulcer 9.5%, and gangrene 3.0%. The presence of foot ulcer was weakly associated with PAD (P=0.052). No significant relationships were found between age, gender, smoking status, duration of diabetes mellitus, hypertension, dyslipidaemia, and PAD. PAD is common in the diabetic population of this study.”

Prognostic value of functional performance for mortality in patients with peripheral artery disease. (J Am Coll Cardiol. 2008)

Progression of peripheral arterial disease predicts cardiovascular disease morbidity and mortality. (J Am Coll Cardiol. 2008)

Serum 25-Hydroxyvitamin D Levels and the Prevalence of Peripheral Arterial Disease. Results from NHANES 2001 to 2004. (Arterioscler Thromb Vasc Biol. 2008) “CONCLUSIONS: Low serum 25(OH)D levels are associated with a higher prevalence of PAD. Several mechanisms have been invoked in the literature to support a potential antiatherosclerotic activity of vitamin D.”

Symptomatic Peripheral Arterial Disease in Women. Nontraditional Biomarkers of Elevated Risk (Circulation 2008) “Conclusions—Among a broad range of biomarkers of cardiovascular risk, only 4 factors, sICAM-1, high-sensitivity C-reactive protein, HDL-C, and TC:HDL-C, were significantly associated with incident symptomatic PAD in women. Findings pertaining to novel biomarkers provide clinical confirmation of a prominent role of endothelial activation and leukocyte recruitment in lower-extremity arterial disease.”

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