Silent but deadly: screening important for peripheral arterial disease.

• Author: Bigelow, Brian C.
• Position: ADVICE: HEALTH

WHILE MOST OF US MAY give careful consideration to our overall heart health during the month of February, one of the "silent but deadly" killers deserving attention is peripheral arterial disease, or PAD. As the most common type of peripheral vascular disease, PAD refers to abnormalities in the arteries outside the heart. The disease state is usually a result of atherosclerosis, or a gradual clogging of the blood vessels with plaques, although dilation (aneurysm) of an artery is also common.

PAD affects approximately 8 million to 12 million Americans, including many in their 50s, and by age 70, more than 20 percent of the population will have it. Risk factors for PAD are similar to coronary artery disease: family history, high blood pressure, high cholesterol, diabetes and tobacco abuse are all important contributors to the development of PAD.

While many individuals have lifestyle-limiting symptoms, up to 50 percent of patients with PAD do not have any symptoms. Diagnosis is critical, as people with PAD face a six to seven times higher risk of heart attack, stroke or loss of limb. This risk can be significantly mitigated by aggressive risk factor modification including tobacco cessation, cholesterol-lowering medications and blood pressure/blood sugar control.

When they occur, symptoms of PAD are related to the artery affected. Blockages in the carotid arteries of the neck may lead to stroke. When the leg arteries are involved, a patient may experience problems ranging from cramping while walking to the need for amputation. Kidney artery obstructions may lead to high blood pressure and reduced kidney function. Additionally, an abdominal aortic aneurysm, or AAA, can be fatal if it ruptures.

Fortunately, the screening tests for the most common types of PAD are simple, noninvasive and inexpensive. Carotid artery narrowing and aneurysms of the abdominal aorta may be identified...