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Peripheral Artery Disease (PAD) is a circulatory condition that affects millions worldwide, yet it remains significantly underdiagnosed and misunderstood. Often dubbed a "silent killer," PAD silently progresses, increasing the risk of heart attack, stroke and limb amputation if left untreated. Understanding PAD is crucial to raising awareness, improving early detection and preventing complications.

Though it is underdiagnosed, one in every 20 Americans over the age of 50 has PAD. This condition is caused by the buildup of plaque in the arteries which restricts the flow of blood to the body’s organs and limbs.

The stealthy nature of PAD

Although some people with PAD experience symptoms such as leg pain, weakness, or discoloration, approximately 50 percent of PAD patients are asymptomatic. Many people also mistake the symptoms of PAD for something else. This makes routine screening important, particularly for individuals at higher risk, such as those with diabetes, hypertension or a history of smoking. By understanding the risk factors associated with PAD, you can take positive steps to reduce your likelihood of developing the disease or, if you‘ve already been diagnosed, slow its progression.

“Peripheral artery disease can be difficult to detect at times,” says Samuel N. Steerman, M.D., a board-certified vascular surgeon at Sentara Vascular Specialists. “Understanding the risk factors is extremely important for both prevention and early detection.”

Risk factors for PAD

• Age: The majority of people in the U.S. who have PAD are age 60 or older.
• High blood pressure: High blood pressure can take its toll on your blood vessels. It can narrow them, as well as cause the arterial plaque buildup that leads to PAD.
• Smoking: Smoking tobacco causes inflammation, damages blood vessels, and accelerates the buildup of arterial plaque which can lead to PAD. Smokers are three to four times more likely to develop PAD compared to non-smokers, and quitting smoking can reduce your risk by 75%.
• Diabetes: Elevated blood sugar levels damage blood vessels over time which can increase your likelihood of developing PAD.
• Lifestyle habits: Being overweight or obese, leading a sedentary lifestyle, and stress, which can tighten and narrow arteries, increase your risk of developing PAD.

Additional risk factors for some people:

• Family history: A family history of PAD or other cardiovascular conditions increases the likelihood that a person will develop PAD. If you have a family history of PAD or related conditions, it’s important to let your doctor know.
• Race and ethnicity: The risk of developing PAD can be greater for certain races and ethnicities. Overall, African Americans face the greatest risk of developing PAD. In general, Hispanic, Latino, and white people share a similar risk, however, a sedentary lifestyle significantly elevates the risk level for Hispanic and Latino adults, even without other risk factors.

How is PAD diagnosed?

PAD is diagnosed based on your signs and symptoms, a physical exam and your medical history. You may also have other tests to find the cause, including:

• Angle-brachial index test – this test compares the blood pressure readings of legs and arms. It may also include an exercise test in which you walk on a treadmill to check your symptoms.
• Doppler ultrasound.
• CT Angiogram.
• Magnetic resonance angiogram or MRA.

The first step to prevent PAD

Lifestyle changes are the first-line recommendation by doctors to reduce your risk of PAD. Suggested lifestyle changes include:

• Quit smoking/reduce exposure to secondhand smoke.
• Maintain a healthy weight.
• Get regular physical activity.
• Eat a heart-healthy diet.
• Reduce stress.

How is PAD treated?

Treatment for PAD depends on the cause of your condition, how severe the symptoms are and your age. Underlying causes also need to be treated and controlled. These include treatment for long-term conditions such as diabetes, high cholesterol and high blood pressure.

Treatment may include:

• Lifestyle changes.
• Taking medications.
• Procedures as needed.

“PAD is a warning sign indicating potential future heart and cardiovascular issues. If you have risk factors or symptoms, talk to your doctor for the best chance at preventing a potential emergency,” says Dr. Steerman.

If you are at risk for PAD or suspect you may be having symptoms, Sentara can help. Contact your primary care provider to assess your risk level. They may recommend a diagnostic test or refer you to a heart and vascular specialist for additional care, as needed.

You can also take advantage of some of our Sentara community health resources, including the Healthy Habits, Healthy You diabetes and heart disease prevention program, and our tobacco cessation program.

More Resources:

• Peripheral Artery Disease