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 also 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 the rate of non-diabetics.” This greater risk of heart attack and stroke is often preceded by symptoms of PAD.
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 are 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.”
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 stroke
- physically inactive
Symptoms of PAD
Although PAD affects approximately 8 million persons in the United States, many physicians routinely do not obtain a relevant history of PAD and frequently overlook subtle signs of the condition.
Sometimes the symptoms of PAD are so subtle that both doctors and patients may not suspect a problem. In some instances, people with PAD may attribute mild leg pain or difficulty walking as a sign of aging and nothing more. Being aware of the warning signs is crucial. If you suspect you might have PAD, look for any one of the following symptoms:
- Leg pain in the calves when walking or exercising that goes away with rest. This is referred to as “claudication”
- Numbness, tingling, or “pins and needles” in the lower legs or feet.
- Cuts or sores on the legs or feet that don’t heal or heal slowly.
Discuss the potential for PAD with your doctor, especially if you have other ailments such as hip and knee arthritis, chronic back pain, or other painful symptoms, as they may eclipse the warning signs of PAD.
Discovery of the condition is often made through a thorough physical exam. The basic test used to diagnose PAD is called the ankle brachial index, or ABI. The ABI compares the blood pressure in your arm to the blood pressure in your ankle. If your lower leg blood pressure is lower than your arm pressure, then you have PAD. Most doctors recommend a resting blood pressure of less than 130/80 mmHg.
If your doctor cannot make a clear diagnosis of PAD by taking your blood pressure, he or she may try other diagnostic measures, such as magnetic resonance angiography or Doppler ultrasound. In the most serious cases of PAD, surgery (balloon angioplasty or arterial bypass) can help open or reroute restricted blood vessels, although the majority of people can manage PAD medically. A combination of medication and lifestyle changes can reduce symptoms and the dangers they present, thereby reducing your chances of having a heart attack or stroke.
If you are at risk for PAD and you smoke, you should stop immediately. Smoking narrows the blood vessels in your heart over time and can make it even more difficult for it to pump blood throughout your body, especially to the lower limbs.
Other methods of preventing PAD include managing your diet and blood glucose levels. Reducing fat, cholesterol, and sodium helps lower blood pressure. A moderate and supervised exercise program is also mandatory for people with PAD, though you should periodically rest if you have any pain in your legs, even if it’s mild. (Most physicians recommend walking three times a week for roughly 30 minutes each time.) High blood pressure must be monitored and controlled with medication. Your doctor may also want to use antiplatelet drugs or aspirin therapy to “thin” your blood making it easy to flow through narrow or restricted arteries.