Creating a Partnership to Remedy a Major Public Health Issue
Peripheral arterial disease (also known as peripheral vascular disease) is a common condition affecting up to 20 percent of Americans age 65 and older. PAD is a disease of the arteries that affects 10 million Americans and can occur at any age, but is most common in men and women over age 50.
PAD develops most commonly as a result of atherosclerosis (“hardening of the arteries”) which occurs when cholesterol and scar tissue build up and form a substance called plaque that narrows and clogs the inside of the arteries. This serious condition causes decreased blood flow to the legs, which can result in pain when walking. It can even lead to gangrene and amputation.
Because atherosclerosis is a systemic disease, (that is to say it can affect the arteries of the body from head to toes,) people with PAD are likely to have blocked arteries in other areas of the body. This means they are at increased risk for heart disease, aortic aneurysms and stroke. PAD is also a marker for diabetes, hypertension, kidney disease and other conditions.
This is a major public health issue that causes more death and disability in our country than all other diseases combined. The cost of treating this is estimated to be over $400 billion annually.
Symptoms of PAD
- The most common symptom of PAD is called claudication, which is leg pain that occurs when walking or exercising and disappears when the person stops the activity.
- Other symptoms of PAD include numbness and tingling in the lower legs and feet, cold lower legs and feet and ulcers or sores on the legs or feet that don’t heal.
Unfortunately, many people with the early symptoms of lower leg PAD, especially leg pain on walking, simply live with their pain, assuming it is a normal part of aging, rather than reporting it to their doctor. Often they will wait until they become severely debilitated.
- High blood pressure
- High cholesterol
- Family genetic history
Get tested if you
- Are over age 50
- Have a family history of vascular disease, such as PAD, aneurysm, heart attack or stroke
- Have high cholesterol or high lipid blood test
- Have diabetes
- Have ever smoked or smoke now
- Are overweight
- Have an inactive lifestyle
- Have a personal history of high blood pressure, heart disease, or other vascular disease
- Have trouble walking that involves cramping or tiredness in the muscle with walking or exercising, which is relieved by resting
- Have pain in the legs or feet that awakens you at night
What tests do I need?
There are simple, non invasive tests to screen for PAD even if you don’t have symptoms. The following can usually be completed in about 30 minutes:
- Ankle Brachial Index (ABI): This test measures the ratio of blood pressure in the ankle to that in the arm. Ankle pressure lower than that of the brachial pressure suggests the person may have hardening of the arteries.
- Abdominal aortic aneurysm screening: Ultrasound test to detect potentially fatal aneurysms in the belly area.
- Carotid artery scan: An ultrasound test that detects blockages leading to the brain.
Ingham Regional Medical Center offers these comprehensive monthly screenings for PAD the third Friday of every month for a cost of $60.
Treatment for PAD
The leading treatment for PAD is risk factor modification. Most individuals with PAD can be treated with lifestyle changes, and in some cases, medication that reduces their risk. Lifestyle changes that can reduce these risks include:
- Stop smoking: smokers are many times more likely to get PAD
- Control blood pressure: By taking medications as prescribed
- Control diabetes: By keeping blood sugar under control
- Get moving: Engage in at least 30 minutes of aerobic physical activity (walking, swimming, bicycling, etc.) each day
- Eat right – control weight: Cut out the junk food and eat a low-fat, low-cholesterol diet generous in fruit and vegetables
- Know your cholesterol: Keep your levels at the recommended numbers
Let’s consider the good news. Of the eight to 10 risk factors that contribute to hardening of the arteries and PAD, the only ones doctors cannot change are your genes and your age. All the other risk factors can be modified or improved.
When the disease has progressed to a more serious degree, medications may be prescribed to control complications from PAD, including aspirin therapy, antiplatelet, anti-thrombotic or cholesterol-lowering therapies.
Creating a partnership is crucial
As a nation, hospitals and physicians have become very good at episodic care in the treatment of atherosclerotic disease; that is to say, doctors can usually fix what is broken. But we recognize that this is an extremely expensive way to deliver healthcare. And the cost is not only monetary, it is also measured in each patient’s quality of life.
Because the disease frequently exists in some patients with or no very tolerable symptoms, and in other patients with intense and complex symptoms, no one should attempt self-diagnosis and treatment.
If we are to have an impact on this devastating disease–a disease that accounts for more death and disability than all other disease combined in our country — we must do it in partnership. Entities such as Ingham Regional Medical Center’s Great Lakes Vascular Institute have been specifically established to bring together state-of-the-art technology with recognized experts in the treatment of atherosclerosis. Together we can impact this disease by prevention, earlier detection and earlier treatment. Partnership has also prove to decrease the economic and social price that our citizens must endure, not to mention the added personal benefit patients enjoy in the form of a better quality of life.
Partnership can include employers as well. Promoting better health is an investment in people and profitability. As companies structure their health benefit programs, encourage them to consider offering wellness programs that promote healthy lifestyles, as well as screening programs that help detect and treat dangerous conditions, including PAD.
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Dr. Alonso Collar is chief of surgery at Ingham Regional Medical Center and chair of the thoracic and cardiovascular section. He also serves as staff surgeon for the Great Lakes Heart Lung and Vascular Institute and medical director of Great Lakes Vascular Institute. Anyone seeking more information on peripheral arterial disease should visit www.irmc.org.