Peripheral Artery (Arterial) Disease (P.A.D.) is an under-recognized and under-diagnosed condition, yet it serves as an important warning sign for those at high risk for stroke and heart attack. Even though we have an inexpensive and non-invasive test for P.A.D. very few people have the test done. I interviewed Dr. Gary Schaer, Director of the Cardiac Cath Lab at Rush University Medical Center in Chicago, about P.A.D. and also spoke with actor Phylicia Rashad about her family’s trials and tribulations with P.A.D. This post is devoted to Dr. Schaer’s insights on the medical aspects of the disease, and the next post focuses on Ms. Rashad’s personal story. To listen to the entire podcast of our interview, please click here.
Dr. Val: To set the stage for our listeners, Dr. Schaer, can you tell us what is peripheral artery disease exactly?
Dr. Schaer: Peripheral Arterial Disease is a condition where the blood vessels (that deliver blood to the legs) become plugged up with a mixture of fat and cholesterol, also known as plaque. This plaque sticks to the blood vessel walls and causes a decrease in oxygen delivery and blood flow to the leg muscles. Patients sometimes experience a burning, aching or tired feeling in their calf muscles (called “claudication”) when the blood supply is diminished. This discomfort is usually made worse by walking but relieved by rest. It’s a fairly common problem, particularly in people with risk factors (like smoking, diabetes, and high cholesterol) for P.A.D. It’s important to recognize when a person has P.A.D. because they could be at higher risk for stroke, heart disease, and even death.
Dr. Val: Why do you think so few people know about P.A.D.?
Dr. Schaer: It’s not as “glamorous or exciting” a disease as heart attack or stroke (as portrayed in Hollywood movies). P.A.D. is a chronic disease that is a marker for atherosclerotic plaque – which can lead to heart attacks and strokes.
Dr. Val: How does the average person know they have P.A.D.?
Dr. Schaer: You can get tested. We have a simple, non-invasive test available to diagnose this disease – it’s called the “Ankle Brachial Index.” The test basically compares the blood pressure in the arm with blood pressures in the thigh and ankle. If there’s a significant drop in the leg blood pressure, then that suggests a blockage of blood flow or P.A.D.
Dr. Val: Who would be a good candidate for the ABI test?
Dr. Schaer: People who have symptoms of P.A.D. (claudication) should definitely be tested. However, keep in mind that about half the patients who have P.A.D. are asymptomatic, so people with risk factors like long-term smoking, age over 65, diabetes, and high cholesterol should consider having the test too. The reason why we do the test is because there are some excellent treatment options that can reduce the risk of heart attack and stroke for people with P.A.D.
Dr. Val: What are the treatment options?
Dr. Schaer: First of all, people with P.A.D. should be on an anti-platelet drug – either Plavix or aspirin. Studies have shown that these drugs substantially reduce the risk of stroke and heart attack (and heart related death) in patients with P.A.D. However, Plavix is more effective than aspirin, though aspirin is cheaper. Secondly, people with P.A.D. must not smoke. Quitting smoking is a top priority. Thirdly, underlying conditions like diabetes, high blood pressure, and high cholesterol must be aggressively managed. And finally, increasing physical activity can also reduce the risk of dangerous complications from the disease.
Dr. Val: What’s the most important thing for Americans to know about P.A.D.?
Dr. Schaer: The most important thing is for Americans at risk for P.A.D. to get tested for it. Anyone over 65 with claudication symptoms or other risk factors like smoking, diabetes, or high cholesterol should get an ABI test from their doctor. If P.A.D. is diagnosed, there are therapies that clearly reduce the risk of having it progress to heart disease, stroke, and even death. Testing could save your life.