Treatment:

There are two treatment goals for PAD and claudication:

• Manage the pain of intermittent claudication, improve functioning, and prevent PAD from getting worse, so that gangrene does not occur.
• Reduce the risk for cardiovascular disease (heart attack and stroke).

Lifestyle changes, especially exercise, are critical for every patient with PAD. Medication is often required to improve function and protect the heart. In very severe cases, surgery may be needed to improve blood flow.

Treatment for PAD also involves managing the medical conditions (diabetes, high cholesterol, high blood pressure) that often accompany it.

Managing Diabetes

Patients with diabetes need to strictly control their blood sugar (glucose) levels. Poor glycemic control is associated with vascular and circulation complications such as PAD. Patients should aim for an A1C level below 7%. The AIC test measures a patientâ ' s average blood sugar over the past 3 months. Patients with diabetes need to follow certain dietary restrictions. Many different types of medications are used to control blood sugar levels. [For more information, see In-Depth Reports #60: Diabetes type 2, #09: Diabetes type 1, and #42: Diabetes diet.]

Managing Unhealthy Cholesterol and Lipid Levels

It is very important for people with PAD to keep their LDL ("bad cholesterol") levels to below 100 mg/dL. If patients have serious heart disease risk factors (high blood pressure, diabetes, other unhealthy lipids) in addition to PAD, they may need to aim for LDL levels below 70 mg/dL. Unhealthy cholesterol levels are major contributors to atherosclerosis, the common factor in PAD and heart disease. Patients should avoid saturated fats and foods that are high in cholesterol. A statin drug may is the most common type of medication used to help lower LDL cholesterol and improve lipid profiles. For some patients, other types of drugs, such as nicotinic acid or fibrate drugs, may be prescribed.

Statins include:

• Lovastatin (Mevacor)
• Pravastatin (Pravachol)
• Simvastatin (Zocor)
• Fluvastatin (Lescol)
• Atorvastatin (Lipitor)
• Rosuvastatin (Crestor)

[For more information, see In-Depth Report #23: Cholesterol .]

Managing High Blood Pressure

In addition to dietary measures to reduce salt and increase potassium intake, various medications are used to control high blood pressure (hypertension). Patients with PAD should aim for blood pressure less than 130/80 mm Hg.

Evidence suggests that the best drugs for patients with high blood pressure and PAD are angiotensin-converting-enzyme (ACE) inhibitors. These drugs block the effects of the angiotensin-renin-aldosterone system, which is thought to have many harmful effects on the heart and blood vessels. They are important drugs for patients with PAD and diabetes who also have high blood pressure. In addition to heart protection, ACE inhibitors may help reduce pain that patients experience when walking.

ACE inhibitors include:

• Captopril (Capoten)
• Enalapril (Vasotec)
• Quinapril (Accupril)
• Benazepril (Lotensin)
• Ramipril (Altace)
• Perindopril (Aceon)
• Lisinopril (Prinivil, Zestril)

[For more information, see In-Depth Report #14: High blood pressure.]