Its no secret smoking and a heavily-Western diet can be detrimental to good health. More often than not, these practices are associated with lung cancer and heart disease. But there is another important concern lurking that often gets overshadowed: their connection to arterial vascular disease like peripheral artery disease (PAD).
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Some experts believe there are between 10 and 12 million Americans who have PAD and have not been diagnosed, says Dr. M. Ashraf Mansour, head of vascular surgery at Spectrum Health and professor of surgery at Michigan State University.
PAD eventually makes walking hard and painful, says Mansour. As the disease progresses and leg arteries narrow because of plaque buildup, PAD becomes a marker for heart disease, putting patients at a high risk for heart attack or stroke.
According to the Vascular Disease Foundation, PAD is a serious disease that affects about eight million Americans.
But there is good news, PAD is largely preventable and quite treatable as long as people learn the symptoms and identify and treat them early.
Baby boomers and elderly at higher risk
Plaque buildup increases as populations age, explaining why todays baby boomers are a target for PAD. According to the Centers for Disease Controls (CDC), 12% to 20% of people older than 60 suffer with PAD; marked increases in the condition appear in people over 80.
Intermittent claudication occurs when blood in the leg is not feeding its target, according to Dr. Thomas Maldonado, associate professor of surgery at New York University Langone Medical Center.
But many people are asymptomatic; the outward indications will not appear until the artery has narrowed by 60% or more. The body can adapt to narrowed arteries by developing smaller peripheral arteries that allow blood flow around the narrowed area. Much like a detour in a traffic jam, this collateral circulation is Mother Natures way of compensating, Maldonado says.
The extreme danger is that blockages can restrict circulation to the limbs and organs. Without adequate blood flow, the kidneys, legs, arms and feet suffer damage. The most advanced stages of PAD can lead to Critical Limb Ischemia (CLI) , meaning the legs and feet have such severe blockage that they do not receive the oxygen rich blood required for growth and repair of painful sores; even gangrene can set in and if left untreated, can require amputation.
Left untreated, in worst case scenarios, people with PAD may become disabled and not be able to go to work. As time goes on, their quality of life worsens.
Do you have PAD?
Theres a whole laundry list of things that can cause leg cramps, says Maldonado.
This can sometimes lead to misdiagnosis, so experts say its important to know your body and be able to recognize symptoms. A "Charlie horse," for example, is also a leg cramp, but it manifests in the muscle and can normally be relieved by rubbing or massaging; it may occur at rest or merely with stretching. The pain from intermittent claudication, however, occurs when walking and will always subside upon resting, except in the most severe of cases.
Knowing PAD can be easily identified by simple, non-invasive tests should allay patient fears of even venturing to the doctor to determine diagnosis.
The ankle-brachial index (ABI) compares the blood pressure measured at the ankle to the blood pressure measured at the brachial artery located in the arm. The pressure in both areas should be the same, according to Maldonado. Less than one, 0.9 or less is considered abnormal and cause for a prompt work up. With severe narrowing, the ABI may be less than 0.5.
When a patient has no ankle pressure, a toe pressure is often compared to the arm, or the doctor may look at wave forms from another study, the Doppler ultrasound. The Doppler measures blood flow and blood pressure by bouncing high-frequency sound waves (ultrasound) off circulating.
Avoiding or living with PAD
"A PAD diagnosis is a wake-up call to change or modify your risk factors, says Maldonado.
Experts say that one of the most important things for PAD sufferers to do is to stop smoking. Even limited amounts of tobacco can be a major detriment in a patient's battle against the disease because nicotine causes the blood vessels to narrow, leaving less room for blood flow and increasing the risk of clot formation.
Diabetes, which can also cause the artery wall to become hard or calcified, high blood pressure or uncontrolled hypertension, high cholesterol and genetics are also risk factors. When we see people with a PAD cramp in the calf, the first thing we do is counsel them on lifestyle modification and give them the five-minute spiel to quit smoking, quit eating the wrong stuff like fatty and fried foods and stop overeating, Mansour says, recommending a Mediterranean diet that includes chicken, fish, grains and salads.
Doctors also stress exercise, especially walking, as treatment and a deterrent. We tell people over and over again that walking 20 to 25 minutes a day is just as good as running and going to the gym.
People can lose weight, and reduce high blood pressure without drugs or the statins that are typically prescribed for high cholesterol. But, with medication versus diet/lifestyle, a lot of Americans are looking for the easy fix, Mansour says.
Research shows that with a lot of people who can strictly modify what they eat will have good outcomes. All they did was change their diets. That can reverse lot of bad things, Mansour says. Ive known of diabetic patients who were taking insulin and went on strict diets and then were able to stop the insulin.
Low-dose aspirin has been shown to reduce incidence of heart attacks and strokes as long as patients are faithful in taking it, says Mansour. However, blood thinners are not recommended for regular population heart or other vascular problems. Mansour says these medications must be monitored strictly to make sure the blood does not become too thin.
Innovative surgical interventions
Surgical options are often required for more developed PAD cases. Twenty years ago 60- or 70-year-old person had very few choices, but they do today, says Rob Lyles, vice president and global leader of of Cook Medicals Peripheral Intervention strategic business unit. Bill Clinton is a classic example of a baby boomer who had poor eating habits and required surgery to stay healthy and prevent restenosis.
Lyles describes the procedure as pretty amazing.
We use tools that can travel from the groin to foot through tiny little arteries one or two millimeters in diameter--the size of a strand of angel hair pasta.
The procedure is minimally invasive with little to no re-cooperation period: Patients are admitted in the morning, up walking around in the afternoon and back at work within a day or two. Its a huge paradigm shift thats less traumatic to the body-- and societally, results in a decreased health care spend.
Good economic technology drivers are the mark of todays innovation, Lyle says. And the grand prize: more healthy patients.