Leg Artery Disease Boosts Heart Risk

Three-quarters of adult Americans polled recently said they knew little or nothing about peripheral arterial disease (PAD), a very common blockage of blood vessels in the legs that boosts heart risk.

"I don't think that was necessarily a surprise among physicians involved in PAD," says Dr. Timothy Murphy, a professor of diagnostic imaging at Brown University in Providence, Rhode Island. Dr. Murphy co-authored a report on the survey, published in Circulation.

"Most of us know that many of the patients at risk don't seek medical attention," says Dr. Murphy. "But it was surprising that the knowledge base was as small as it was, considering that there are 8 million people in the US with the disease."

Fatty Deposits Cause Blockage

In PAD, arteries in the legs are narrowed or blocked with fatty deposits. These obstructions can cause leg pain but often produces no other symptoms.

PAD can damage legs enough to require amputation, and it can also signal a raised risk of heart attacks or strokes caused by a narrowing of the arteries elsewhere in the body.

Three-quarters of the 2,051 people ages 50 and over questioned via phone in the survey said they were aware of strokes, and two-thirds knew about risks of coronary artery disease and heart failure.

But just 25 percent knew about PAD - far behind awareness levels for much rarer conditions, such as amyotrophic lateral sclerosis or Lou Gehrig's disease (36 percent) and multiple sclerosis (42 percent).

Among the one in four adults who were aware of PAD, only 28 percent associated it with an increased risk of heart attack, and just 14 percent linked it with amputation and death.

That is no big surprise, says Dr. Murphy, since "the link between PAD and heart attacks and stroke is just becoming disseminated among primary-care physicians."

Relatively few family physicians routinely perform the basic diagnostic test for PAD, called the ankle-brachial index, he says.

Blood pressure is measured in the arm and at the ankle, with the measurements repeated at both sites after five minutes of walking on a treadmill.

Lower pressure at the ankle indicates PAD. The lower the ankle-brachial index, the greater the danger.

"The test is not often done in a primary-care physician's office," explains Dr. Murphy. "It is not reimbursed under Medicare unless there are symptoms, and it is hard to ask physicians to do a test unless they are reimbursed. We are trying to get support for Medicare to reimburse for it as a diagnostic test."

Pain Symptoms Sometimes Go Unheeded

Diagnosis of PAD indicates the need for attention to the well-known risk factors for arterial blockage elsewhere in the body, such as smoking, high blood pressure, cholesterol levels, and lack of exercise, says Dr. Alan T. Hirsch, at the University of Minnesota and another author of the report.

Lack of awareness means that even adults who have leg pains or other symptoms of PAD are not aware of its dangers, notes Dr. Hirsch. "At a time when the public is bombarded with health messages, it would seem wise for those with one of the single most common cardiovascular diseases to be aware of the risk."

The survey also shows that physicians are not doing enough about awareness of PAD risk, says Dr. Hirsch.

While 26 percent of those in the survey who were aware of PAD said they got information from broadcast media such as television, only 19 percent reported first hearing about PAD from a health-care provider.

Physicians should be aware of PAD symptoms as a major warning sign of potential trouble, says Dr. Hirsch. "Denigrating leg pain as unimportant is as logical as avoiding chest pain."

Dr. Murphy is a member of the Peripheral Arterial Disease Coalition, which conducted the survey. The coalition is funded by grants from the Bristol-Myers Squibb/Sanofi Aventis Partnership (both members of the Partnership are drug companies) and medical device maker Cordis Endovascular, a division of Cordis Corp.

Always consult your physician for more information.

PAD: When To Seek Care

The National Institutes of Health (NIH) says there are many causes of leg pain, such as arthritis or low blood potassium.

However, some causes of leg pain may be life-threatening, such a blood clot in the legs.

Seek medical attention if you have leg pain that does not go away, legs that are red, hot, or swollen, chest pain or shortness of breath with leg pain, diabetes, or if you are pregnant.

Your health care provider will perform a physical examination and ask questions about your cramping leg pain and other symptoms, such as:

• Do you have leg cramps at night?

• How often does leg pain with cramping occur?

• Is it getting worse?

• Is the pain sharp?

• Is there an aching pain with the cramps?

• Is it worse after you exercise?

• Is it worse after you are standing?

• Do you smoke? How much?

• Do you drink alcohol? How much?

• Are you diabetic? How well is your blood sugar controlled?

• What other symptoms are also present?

• Has there been impotence (men)?

• Is there pain in the back?

• Is there a darkening of the skin of the legs, feet, or toes?

• Is there weakness or paralysis of the legs?

The provider may check the pulse in the groin and other areas where the pulse can be felt in the legs.

The following tests may be performed:

• blood pressure measured in arms and legs for comparison

• Doppler ultrasonography on the legs and the heart

• duplex Doppler and ultrasound exam of extremity to see how blood flows through arteries

• ECG to check the activity of your heart

• aortography to see blockages in your large arteries

Surgery or angioplasty may be recommended if leg pain interferes with the patient's activities or work, and if the diseased arteries are likely to improve after corrective treatment.

Always consult your physician for more information.