Peripheral Artery Disease: What to Know and Do

Diabetes raises your risk; these treatments can help

Peripheral artery disease (PAD) “pads” arteries in your legs (and elsewhere) with gunky plaque that strangles or even cuts off blood flow, causing muscle pain and – grisly but true -- raising risk for amputation, too. It’s a particular health concern for people with diabetes, but new research suggests that cholesterol-lowering drugs can help.

artery pain


“It’s smart to begin getting screened for PAD about five years after you’ve been diagnosed with diabetes,” says San Francisco endocrinologist Alan L. Rubin, MD, author of Diabetes for Dummies and Prediabetes for Dummies. “The test is very simple – your doctor checks blood pressure at your ankle and compares it to blood pressure reading from your arm. Lower blood pressure in your legs is a warning sign.”

So is severe pain. Diabetes promotes the build-up of plaque in blood vessels and can also trigger plaque break-ups that clog arteries. As a result, people with type 2 diabetes are three times more likely to have PAD than people without diabetes1 and are also three to eight times more likely to have symptoms like achy legs.2 Higher blood sugar also means higher risk for even more serious problems. Every one-point increase in A1c boosts risk for a PAD-related amputation 44 percent for people with type 2 and 18% for people with type 1 according to a 2010 review from the UK’s Cambridge University Foundation Hospital Trust.

PAD is also a sign that you’re at risk for heart disease, heart attacks and stroke, Dr. Rubin says. “Doctors take it very seriously,” he notes. “If you have atherosclerosis in your legs, you have it in arteries elsewhere in your body, too. PAD is treated by controlling blood pressure and reducing high cholesterol levels.

It works. In a recent Emory University study4 that followed the health of 208,275 military veterans with PAD for five years, those who took cholesterol-lowering statin drugs had a 22-33 percent lower risk of losing a leg or other limb to amputation compared to people in the study who didn’t take a statin. They were also 22-29 percent less likely to die. The study participants, most of whom were men, had an average age of 67; 47 percent had diabetes. One fact that highlights PAD’s seriousness: During the study period, 17,643 participants had an amputation. 

“PAD is the next cardiovascular epidemic,” says lead author Shipra Arya , M.D., S.M., an assistant professor in the division of vascular surgery at Emory University School of Medicine in Atlanta, Georgia. “It is characterized by the same arterial stiffening and plaque formation as heart disease. When blood flow to the legs is compromised due to these plaques/cholesterol deposits, it can lead to amputations. Statins lower cholesterol levels and provide stability to these plaques so they don’t compromise blood flow to the legs. Therefore it can prevent amputations.”

A PAD Primer

Wondering if you’ve got PAD…and what to do next? Here’s what to know about risk, warning signs, tests and treatments:

More PAD risks: Your odds may be even higher if you smoke, are overweight, have high blood pressure or cholesterol, don’t exercise often, are over age 50 or have a personal or family history of heart attack, stroke or heart disease.5

PAD symptoms: Leg pain, especially when you’re active (such as walking or climbing stairs), that disappears when you rest for a few minutes; numbness, tingling or coldness in your lower legs or feet; slow-healing sores and infections on your feet or legs. Other signs of poor circulation due to PAD include pale or blue-ish-looking skin, slow-growing toe nails and decreased leg-hair growth according to the National Heart, Lung and Blood Institute.6

Screening test: The ankle brachial index (ABI). “This compares blood pressure at your ankle and arm,” Dr. Rubin explains. “If the result is lower than .95, you may have PAD.” An American Diabetes Association expert panel recommends the ABI for anyone over age 50 who has diabetes; get it sooner if you have symptoms. Imaging tests, such as an ultrasound, an MRI (magnetic resonance imaging) or an angiogram (using dye and X-rays to track blood flow) can also be used to diagnose PAD.7

Treatments: Your doctor may prescribe drugs to lower blood pressure, improve cholesterol levels and discourage the formation of blood clots. In addition, you may receive medications to reduce pain. Severe PAD may require surgery to remove plaque, open blocked leg arteries or replace clogged arteries with a grafted blood vessel from another part of your body.

Call your doctor right away if you have PAD symptoms. “Pain or difficulty walking are early signs of PAD called claudication. Medical management with statins and lifestyle changes including exercise are usually the first line treatment. Non-healing wounds and/or toe discoloration are advanced symptoms called critical limb ischemia (CLI),” Dr. Shipra says. “For patients with CLI, the chance of losing the leg is almost 25% in 2 years. Starting the correct medications including statins and possibly improving blood flow through surgery or endovascular interventions can help prevent an amputation.”

Updated on: February 12, 2019
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