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Peripheral artery disease and intermittent claudication

Description

An in-depth report on the causes, diagnosis, and treatment of peripheral artery disease.

Alternative Names

Peripheral arterial disease; PAD; Peripheral vascular disease;

Risk Factors

About 10 million American adults have peripheral artery disease (PAD). Although it was once believed that PAD occurs more often in men than women, current research now indicates that both genders are equally susceptible. African Americans have twice the risk for PAD as Caucasians.

PAD Risk Factors

The most important risk factors for PAD and intermittent claudication are the same as the major risk factors for heart disease and stroke. People with a combination of these conditions (including PAD) are at increased risk of a more severe form of the heart or circulatory disease. Smoking and high cholesterol levels may increase the risk for PAD progression in large blood vessels (such as the legs), while diabetes increases the risk for PAD in small blood vessels (such as the feet). Quitting smoking and controlling cholesterol are the two best ways to slow PAD progression.

The most important risk factors for PAD include:

• Smoking . Experts believe that smoking is the number one risk factor for PAD and that smoking even a few cigarettes a day can interfere with PAD treatment. Smoking increases the risk for PAD by 2 - 25 times, with the danger being higher when other risk factors are present. One study reported that 90% of patients with PAD were current or former smokers. [For more information, see In-Depth Report #41: Smoking.]
• Diabetes . People with type 2 diabetes have 3 – 4 times the normal risk for PAD and intermittent claudication. In fact, their risk for PAD is higher than their risk for heart disease. People with type 2 diabetes also tend to develop PAD at an earlier age and have more severe cases. Patients with both diabetes and PAD are at high risk for complications in the feet and ankles. In one study, people with diabetes and intermittent claudication had a 30% chance of developing skin ulcers on their legs. [For more information, see In-Depth Report #60: Diabetes - type 2.]
• Unhealthy cholesterol and lipid levels . The risk for PAD increases by 10% with every 10 mg/dL increase in total cholesterol levels. Low levels of high-density lipoprotein (HDL, the so-called good cholesterol) and high triglyceride levels also increase the risk for PAD. [For more information, see In-Depth Report #23: Cholesterol.]
• Hypertension . High blood pressure doubles the chances for PAD. [For more information, see In-Depth Report #14: High blood pressure.]

• Family history of heart and artery disease . Genetic factors that cause specific lipid and cholesterol abnormalities may increase the risk for PAD.
• Artery inflammation and damage . High levels of C-reactive protein can indicate persistent inflammation in the arteries. Such inflammation can cause significant damage in blood vessels, and is highly associated with PAD
• Age . PAD occurs more frequently in people over age 50 and affects 12 – 20% of Americans age 65 years and older.
• Ethnicity . African Americans are at highest risk for PAD. They are twice as likely to develop PAD as Caucasians.

Emerging or Possible Risk Factors

Homocysteine. Abnormally high blood levels of the amino acid homocysteine have been linked to an increased risk of heart disease, stroke, and PAD. Excessive levels occur with deficiencies of vitamins B6, B12, and folic acid. Scientists are continuing to research connections between homocysteine and heart and vascular disease. Some experts believe that high levels of homocysteine are only indicators, not causes, of heart disease.

Infectious Organisms. Some microorganisms and viruses may be able to trigger the inflammation and damage in the arteries that contribute to heart disease and peripheral artery disease.

The primary suspect has been Chlamydia pneumoniae, a non-bacterial organism that causes mild pneumonia in young adults. In one study, treatment with antibiotics in patients with evidence of a previous C. pneumoniae infection appeared to reduce PAD-related plaque build up. However, until better studies are conducted, experts do not recommend antibiotics to treat heart disease or PAD even in patients with evidence of C. pneumoniae .

It should be noted that many people have been infected with C. pneumoniae , and some studies have found no evidence that it increases the risk for heart disease.

• Review Date: 3/29/2007
• Reviewed By: Harvey Simon, MD, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital

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