A leg up on peripheral artery disease

The occasional leg pain or stiffness is often not cause for concern, but if pain or fatigue develops after just a few minutes of walking or climbing stairs, it could be an early sign of peripheral artery disease (PAD).

“PAD not only interferes with an active lifestyle, but also can put you at higher risk for a heart attack and stroke,” says Dr. Michael Belkin, chief of the Division of Vascular and Endovascular Surgery with Harvard-affiliated Brigham and Women’s Hospital. “You can’t cure PAD once it occurs, so you want to take measures to avoid it as much as possible.”

Peripheral artery disease356228Peripheral artery disease occurs from plaque buildup in arteries, which restricts blood flow.
 Illustration by Scott Leighton

What causes PAD?

PAD occurs when the arteries that carry blood to the leg muscles become narrow, often because of a buildup of fatty plaque. An estimated 10 million Americans have PAD, and it usually strikes after age 50. In addition to older age, risk factors include smoking, high cholesterol, high blood pressure, diabetes, and a history of heart disease or stroke.

Leg pain and fatigue are the most dominant PAD symptoms and usually occur with activity, but go away with rest. Blood flow carries oxygen to tissues. When you walk, your leg muscles need more oxygen, but the blockages in the leg arteries won’t allow the blood flow to increase, so the muscles hurt from a lack of oxygen. “This lack of blood flow also can cause lactic acid — which the body uses as energy by breaking down glucose — to build up quicker, which leads to aching, cramping, and fatigue,” says Dr. Belkin.

Plaque buildup doesn’t affect only the legs. “If you have blockages in your leg arteries, you probably have blockages in the arteries leading to your heart and brain, which can raise your risk for a heart attack or stroke,” says Dr. Belkin. Other problems associated with poor blood flow to the legs include foot and leg pain, foot sores that won’t heal, and impotence.

Walk this wayWalking is the ultimate catch-22 with PAD — it helps, but it also hurts. The solution is to begin slow and pace yourself. For example, begin with a five- to 10-minute walk. “If you experience any pain, stop and rest until the pain subsides, then begin walking again,” says Dr. Michael Belkin, chief of the Division of Vascular and Endovascular Surgery with Harvard-affiliated Brigham and Women’s Hospital. “Continue the cycle until the time period has elapsed.” Walk every other day at first, and then progress to more days and longer periods. “As you improve, you should find that walking becomes easier and you have fewer stop-and-rest periods,” says Dr. Belkin. “Eventually, you want to build up to walking for at least 30 minutes, five times a week. This is a good target to help prevent PAD, too.”

Diagnosis and treatment

Diagnosing PAD begins with a physical exam. Your doctor feels the pulses in both your legs to identify any reduction in blood flow. He or she may order a noninvasive test called an ankle-brachial index to compare the blood pressure in your arms and legs. You also may undergo imaging tests, such as ultrasound or MRI, to see if a specific artery is blocked.

Treatment begins with lifestyle changes. If you smoke, you need to stop immediately. In addition, you should eat a heart-healthy diet and begin a regular walking program. You also may need to take a daily low-dose aspirin to prevent blood clots and a statin to lower your LDL (bad) cholesterol.

A drug called cilostazol (Pletal) can increase blood flow to muscles and reduce pain from walking. If one of the leg arteries is quite narrow, you might need angioplasty, a procedure to restore blood flow through a clogged artery.

Take a walk

Unfortunately, PAD can’t be cured once you have it. “The goal is to control its progression by addressing the main risk factors through diet, lifestyle, and exercise,” says Dr. Belkin. “This approach is not only the best way to manage PAD, it’s also the best way to prevent it.”

A walking program is essential, and it offers a wide range of benefits. “Walking increases blood flow in the smaller arteries of the legs and helps create new channels to help move blood around the blockages,” says Dr. Belkin. “This in effect brings more blood flow and oxygen to your leg muscles.” Walking also helps prevent PAD because it can reduce the formation of fatty plaque deposits inside arteries.

Bible verses for today’s meditation and inspiration: Matthew E. McLaren

 “Finally, brothers and sisters, whatever is true, whatever is noble, whatever is right, whatever is pure, whatever is lovely, whatever is admirable–if anything is excellent or praiseworthy–think about such things.” – Philippians 4:8

 “Therefore I tell you, whatever you ask for in prayer, believe that you have received it, and it will be yours.” – Mark 11:24

 “Anxiety weighs down the heart, but a kind word cheers it up.” – Proverbs 12:25

 “Who of you by worrying can add a single hour to your life?” – Luke 12:25

 “For I know the plans I have for you, declares the Lord, plans for welfare and not for evil, to give you a future and a hope.” – Jeremiah 29:11

“If you, then, though you are evil, know how to give good gifts to your children, how much more will your Father in heaven give good gifts to those who ask him!” – Matthew 7:11

 “A cheerful heart is good medicine, but a crushed spirit dries up the bones.” – Proverbs 17:22

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