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New Information about Peripheral Arterial Disease and Diabetes

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Peripheral arterial disease (PAD) occurs when the openings in your blood vessels become narrow and limit the flow of blood to your legs and feet. Why is it especially important for people with diabetes to be aware of PAD? Because diabetes is one of the major risk factors for the condition. People with diabetes are twice as likely to have PAD as people who do not have diabetes.

PAD affects an estimated 8 to 10 million people in the United States. It's a form of atherosclerosis, or hardening or narrowing of the arteries caused by the buildup of plaque. This plaque buildup slows down blood flow, increasing the risk of heart attack and stroke. You may have heard about this type of narrowing in the arteries of the heart, which is called coronary artery disease. PAD is the same type of condition, but it occurs in the arteries of the arms, legs and feet.

Affecting small and large vessels; symptoms differ for each

PAD can affect the small blood vessels and the large ones. Recent research, published in the journal Circulation, indicates that the biggest risk factor for small vessel PAD is diabetes. The most common symptom of small vessel PAD is having feet that feel cool to the touch and that heal slowly after they've been hurt.

On the other hand, common symptoms of large vessel PAD include painful cramps in the hips, thighs or calves. The cramps tend to become less severe after you rest for a few moments. The same research that showed diabetes as the biggest risk factor for small vessel PAD also showed that smoking was the biggest risk factor for large vessel PAD. Other important risk factors identified in the study included high blood cholesterol and heavy consumption of alcohol (about 21 drinks per week).

Other, less common symptoms of PAD include

  • High blood pressure
  • Kidney failure
  • Abdominal pain and vomiting
  • Dry skin
  • Sores on the feet and lower legs

    In its later stages, PAD can become much more severe, causing disability. People often mistake their leg pain as simply a normal part of aging, but this is not the case. Most people can control their symptoms if their PAD is diagnosed and treated.

    Additional risk factors for PAD

    In addition to having diabetes, smoking, high blood cholesterol and heavy consumption of alcohol, other risk factors for PAD include

  • High blood pressure (hypertension)
  • Heart disease (or having had a heart attack or stroke)
  • Being overweight
  • Being physically inactive
  • Age older than 50
  • Family history of heart disease, heart attacks or stroke

    How do doctors diagnose PAD?

    PAD is most commonly diagnosed using a painless measurement. If the blood pressure measurement in the ankle is 90 percent less than the measurement in the arm, or if the toe measurement is 70 percent less than the arm, PAD is likely to be present. The recent research published in Circulation indicates that it's important for the toe measurement to be taken as well as the ankle measurement.

    PAD treatment

    Anti-platelet medication is the most common treatment for PAD. For some people, this may simply mean taking aspirin every day. For others, a prescription medication may be more effective. The Food and Drug Administration has approved the use of a drug called clopidogrel for prevention of heart attack in patients with PAD. Other treatment may involve regular exercise and an adjustment in eating habits.

    Tight control may significantly reduce development of small vessel PAD

    If you have diabetes, consider discussing your risk of PAD with your doctor. Treatment is fairly simple for most people, and can significantly reduce your risk of heart attack and stroke.



    Source:
    American Diabetes Association; Journal of the American Medical Association, 19 September 2001; New England Journal of Medicine, 24 May 2001; Journal of Applied Research



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