ACP SPECIAL REPORT Learning About Peripheral Artery Disease

A C P S P E C I A L R E P O R T

Learning About

PeripheralArtery Disease

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This report courtesy ofPrimary Care PhysicianBoard Certified Internist

Heal n Cure For appointments call

847 686 4444For Information, visitwww.healncure.com

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Knowing the Risks page 3What Are the Signs? page 4What Happens to Your Body page 5Prevention & Control page 6Methods of Treatment page 7Doctors for Adults back cover

Peripheral artery disease (PAD) is aform of atherosclerosis—the hardening andnarrowing of the arteries, caused by the gradualbuildup of fatty deposits and other substances.The term “PAD” includes all disorders that affectthe arteries outside the heart. This pamphlet,however, will focus on the most common form of PAD, inwhich the flow of blood is restricted mainly in the arteries thatlead to the legs.

Many people with PAD (often called PVD, or peripheralvascular disease) have no symptoms, but others have pain, forinstance, in their legs while they walk. The pain goes awaywhen they rest. Whether or not they have symptoms, peoplewith clogged arteries often have damaged blood vessels in otherparts of their bodies too, putting them at a higher risk for heartattack and stroke.

By working with your doctor, you can learn about your risks,how to reduce them through lifestyle changes and what to dowhen you have symptoms of PAD. Read on to learn more.

What Is Peripheral Artery Disease?

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©2004 The StayWell Company407 Norwalk St., Greensboro, NC 27407 www.StayWell.com All rights reserved.

Talk to your doctor, use this guide, call 1-800-AHA-USA1 or go to www.americanheart.org or www.vascularfoundation.com to learn more about peripheral artery disease.

This ACP Special Report on peripheral artery disease ismade possible by the American College of Physicians and aBristol-Meyers Squibb/Sanofi Pharmaceuticals Partnership.




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Knowing the

PAD affects 8 million to 12million people in the UnitedStates, including 12 percent to20 percent of those over age65. By age 70, almost 20percent of the population isaffected. It occurs in both menand women.

Answering the questions atright will help you know if youare at risk. The more “yes”answers you have, the moreimportant it is to see yourdoctor.

Are you at risk for PAD? □ Do you smoke?

□ Do you have diabetes?

□ Do you have high cholesterol?

□ Do you have high blood pressure?

□ Are you over age 50, with a history ofsmoking and/or diabetes?

□ Are you over age 70?

□ Do you have a family history of PAD,cardiovascular disease or stroke (imme-diate family such as parent, sister orbrother)?

□ Do you have muscle discomfort, crampingor pain in your legs when you walk that isalways relieved by rest?

□ Do you have any ulcers or sores on yourlegs or feet that are slow to heal?

□ Do you have a history of coronary arterydisease (a heart attack, angina, angio-plasty or bypass surgery) or stroke?

Who Is Likely to

Get It?RISKS

The risks forperipheral arterydisease are similarto those associatedwith other cardio-vascular diseases.




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Leg Pain or DiscomfortCommon symptoms in people who have

early-stage peripheral artery disease arecramping, fatigue, heaviness, pain ordiscomfort in the thighs, calves or hipsduring activity. Such leg muscle cramping iscalled “intermittent claudication” andalways subsides when the activity stops.

But many people with the disease have nosymptoms at all, and only about a third haveany leg symptoms. The disease often goesundiagnosed because of a lack of symptoms,especially during the early stages, or becausepeople mistakenly think the symptoms are anormal part of aging or related to arthritis.

By the time many people feel leg discom-fort or pain, the arteries may already beseverely blocked. If you believe you mayhave PAD symptoms, ask your doctor tocheck your leg arteries.

Signs of Severe PAD� Foot pain at rest� Non-healing foot or toe wounds� Gangrene

Looking for Symptoms

and SignsLack of symptoms cankeep PAD victims in thedark while the diseasedevelops.

What are theSIGNS?

Diagnosis of PAD begins witha medical history and physicalexam. The doctor may detectweak pulses in the legs with aspecial “stethoscope” called aDoppler device. The doctor may order a Doppler ultrasoundtest, also known as ABI (ankle-brachial index), which usessound waves to detect reducedblood flow in arteries; or aduplex ultrasound, magneticresonance angiogram, CTangiogram or regular catheter-based angiogram, which candetermine how narrow theartery is.

Diagnosing PAD




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Arteries ThickenPAD is caused by a thickening of the walls of the

arteries. These thickened areas, called plaques,create a condition called atherosclerosis, or hard-ening of the arteries. The space through whichblood can flow becomes smaller, decreasing thesupply of oxygen and nutrients to the leg muscles.This condition can cause damage to the tissuesaround the arteries.

AtherosclerosisAtherosclerosis usually occurs when a person has

high levels of cholesterol, a fat-like substance, in theblood. Other factors contributing to its causeinclude smoking, diabetes, high blood pressure andhigh blood cholesterol. Cholesterol and fat circu-lating in the blood can build up on the inside walls ofthe arteries. When the cholesterol level is high, thechance that it will be deposited onto artery walls ishigher.

Tissue DeathOver time, the artery can become so narrow the

person has pain at rest (B). When the artery becomesnarrow enough or blocked (C), too little oxygen getsthrough and tissue death can set in, resulting ininfection or gangrene, and possibly amputation.

When arteries narrow, lack of blood can starve thetissues surrounding them.

What Happens toYOUR BODY

Stemming the

FlowA

B

C




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Not surprisingly, the steps taken to helpprevent PAD are the same as those taken tocontrol it.

SmokingSmoking tobacco is a major risk factor for

PAD. Smokers, on average, are diagnosed withPAD up to 10 years earlier than are non-smokers. Quitting smoking—or neverstarting—is the most important thing you cando to prevent PAD or slow it down.

DiabetesPeople with diabetes may be more likely to

develop vascular diseases. If you are diabetic,you should be under medical care. You alsoneed to keep your blood pressure and cholesterolunder tight control to avoid cardiovascularcomplications.

High Blood PressureHigh blood pressure is another condition

that can damage the arteries. Blood pressurecan often be reduced enough by diet and exer-cise. If this does not lower it adequately,medication can also be added. It is importantto lower blood pressure if it is too high.

ExerciseStudies have shown that exercise produces

significant increases in the distances PADpatients can walk without pain. Walking andregular leg exercises using a motorized tread-mill three to four times a week, ideally in aprogram of supervised rehabilitation, areproven to be effective to decrease claudicationsymptoms.

DietSince people who have PAD usually have

high cholesterol as well, a low-cholesterol,low-saturated-fat diet and other strategies tolower cholesterol should be adopted.

GainingControl

Talk to your doctor before undertakingany exercise or treatment program.

Prevention & CONTROL

As in other artery-relateddiseases, lifestyle changescan go a long waytoward preventing andtreating PAD.




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Most people with PAD will be ableto be managed with risk factor modi-fication, exercise and claudicationmedications.

Lifestyle, MedicationYour doctor may create a program that

includes an exercise program and a low-saturated-fat, low-cholesterol diet. Forthose with claudication, a program ofsupervised exercise training typicallyconsists of 30- to 45-minute sessions threeto four times a week. This will help to increase the distance they can walkwithout discomfort or pain. Medicationsprescribed to help improve walkingdistance in patients with claudicationinclude cilostazol and pentoxifylline. Othermedications that may be prescribedinclude antiplatelet agents (includingaspirin and clopidogrel) to reduce the riskof heart attack or stroke, and medicines tolower cholesterol or reduce high bloodpressure.

For the minority of patients for whomlifestyle modification, an exercise programand medications are not enough, angio-plasty or surgery may be warranted.

Angioplasty and StentsAngioplasty is a procedure in which a

thin tube—a catheter—with a balloon onthe tip is inserted throughthe skin into the blockedartery and the balloon isinflated. The reopening ofthe artery allows the bloodto flow. A stent is a tinywire mesh cylinder thatcan be implanted into theclogged artery at the timeof angioplasty using thecatheter. The stent actslike a scaffolding and holdsthe artery open.

SurgerySurgery may be neces-

sary to treat severenarrowing of the arteries. A vein fromanother part of the body or a syntheticblood vessel is used to bypass the narrowedarea of the artery.

Methods ofTREATMENT

Taking Action

For mostpeople, exercise,medicationand changesin lifestyle are enough to slow theprogression and evenimprovethe symptoms of PAD.

The American Heart Association spent about $389 million during fiscal year 2001-02 on researchsupport, public and professional education and community programs.The organization includesmore than 22.5 million volunteers and supporters who carry out its mission in communities acrossthe country.The association is the largest nonprofit voluntary health organization fighting heartdisease, stroke and other cardiovascular diseases, which annually kill more than 931,000Americans. For more information about heart disease and stroke, call 1-800-AHA-USA1 or visitwww.americanheart.org.




What is the American College of Physicians?The American College of Physicians (ACP) is the largest medical

specialty society and second-largest physician group in the UnitedStates. Its membership includes more than 115,000 internal medicinephysicians, related subspecialists, and medical students. Internists treatthe majority of adults in the United States. ACP’s mission is to enhancethe quality and effectiveness of health care by fostering excellence andprofessionalism in the practice of medicine.

What is a doctor of internal medicine? Doctors of internal medicine, often called “internists,” focus on adult

medicine. They care for their patients for life—from the teen yearsthrough old age. Internists have had special training that focuses on theprevention and treatment of adult diseases. At least three of their sevenor more years of training are dedicated to learning how to prevent, diagnose and treat diseases that affectadults. Some internists take additional training to “subspecialize” in one of 13 areas of internal medicine,such as cardiology or geriatrics. Internists are often called upon to act as consultants to other physicians tohelp solve puzzling diagnostic problems.

What’s an “FACP”? The letters “FACP” after a physician’s name means he or she is a Fellow of the American College of

Physicians, a mark of distinction for an internist. ACP Fellowship is an honorary designation that recog-nizes service and contributions to the practice of medicine—it says that the doctor is committed toproviding the best health care possible.

Why choose an internist for your health care?An internist, just like a family practice or general practice doctor, can serve as your primary care doctor.

But internists are unique because they focus on adult medicine. Internists don’t deliver babies, they don’ttreat children and they don’t do surgery. They do, however, have wide-ranging knowledge of complexdiseases that affect adults. With in-depth training in adult medicine, an internist is your best choice tohelp you navigate the increasingly complex world of medical care.

An internist can treat you for something as routine as the flu, or provide in-depth care for diseases suchas diabetes, cancer or heart disease. Internists often coordinate the many subspecialists a patient might seein the process of treating an illness. Internists’ patients like knowing that they have a relationship with aphysician who is equipped to deal with whatever problem the patient brings—no matter how common orrare, or how simple or complex.

Doctors forADULTS

For more information about internists and internal medicine, visit www.doctorsforadults.com.

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ACP SPECIAL REPORT Learning About Peripheral Artery Disease

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