Clot Chronicles: Peripheral Arterial Disease

Hello, this is Dr. Umberto Campia from Brigham and Women’s Hospital. I’m a cardiologist and vascular medicine specialist, and I’m also an Assistant Professor of Medicine at Harvard Medical School. 

Today we are going to talk about peripheral arterial disease (PAD), which is a manifestation of atherosclerosis that involves the vessels that feed our extremities, most commonly the lower extremities. PAD is a common disease. And, if we consider patients who are in their 60s and 70s, up to 20% may present with PAD. 

And, PAD is associated oftentimes with symptoms that can be disabling and life-limiting. But, in association with symptoms, peripheral arterial disease may also increase the risk of having deadly complications such as heart attacks or strokes. That’s why recognition of the presence of PAD is a very important aspect in managing patients who may have an increased risk for atherosclerosis. 

What are these risks that may lead to the formation of cholesterol plaques that obstruct blood flow to the limbs? The main risk factors are aging, which unfortunately is not something that we can do much about. The second is diabetes. And diabetes is now becoming a very common disease due to the obesity epidemic that has been going on in the US in the last two decades. And, diabetes increases the risk of PAD and also the risk of complications from it, particularly amputation. 

The other major risk factor is smoking. And smoking, unfortunately—despite the aggressive campaign to reduce the prevalence of among our population—still represents a major risk factor. The other risk factors are high cholesterol and high blood pressure. Another common disease that is associated with the occurrence of PAD is chronic kidney disease, particularly when patients have lost their kidney function and are on hemodialysis. 

Now what are the symptoms of PAD? The most common symptom is pain in the calves or the thighs or sometimes the buttocks when the patient is walking. This pain occurs at variable times after the patient starts, and the shorter the time, usually the more severe the blockages are. The pain tends to get worse the more the patient walks and then tends to go away pretty quickly after the patient stops. So, this is called also the “window shopper’s disease.” It’s typical that patients walk for a little bit, and then they stop to watch windows. And it’s not just because they may be seeing very interesting items, but also because they may get relief from their pain. 

How do we treat the patients who have PAD? Until recently, we did really not have many effective treatments besides smoking cessation, which is still one of the most important aspects in decreasing cholesterol and treating diabetes and hypertension. Luckily, in the last few years, new agents have been introduced that can decrease the risk of developing heart attacks and strokes and can also lower the risk of developing limb damage that leads to amputation.

One very effective form of treatment that reduces both the symptoms—so the pain when walking—and the risk of heart attacks and strokes is an exercise program. Usually, this program takes place 3 times a week and lasts up to 12 weeks and is done in appropriate centers that are equipped and have trained personnel. 

PAD is a disease that can be treated and is a disease that deserves more attention. It deserves—particularly by the noncardiovascular expert—more consideration because it’s associated with severe disability and also with a high risk of heart attack and stroke.

Signing off for Clot Chronicles, this is Umberto Campia. Goodbye.

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