Atherosclerosis occurs when artery walls thicken, narrowing the blood vessels and potentially blocking them. This inflammatory condition involves the gradual buildup of plaque (made of cholesterol-rich fatty deposits and other substances) in the artery walls.
You may know that atherosclerosis occurs in arteries supplying blood to the heart—this is called coronary artery disease, and it can cause angina and a heart attack. But, in fact, atherosclerosis is systemic and affects other parts of the body as well. Plaque buildup in arteries supplying the brain, for instance, can result in a stroke. When it occurs in the limbs, usually the legs, this condition is called peripheral artery disease (PAD). More than seven million older Americans have PAD.
PAD can cause muscle pain and cramping (known as intermittent claudication) in the legs or hips, especially when walking, since the working muscles can’t get the extra blood they need. In most cases, however, PAD is less severe and produces no symptoms. If the impaired circulation is very severe and left untreated, it can lead to foot wounds that won’t heal and even gangrene, resulting in amputation.
Besides the localized problems it can cause, PAD is a warning sign that your entire circulatory system is in danger and that you’re at very high risk for a heart attack or stroke. And the reverse is also true: If you have coronary artery disease, you have a one in three chance of developing PAD.
Despite this, PAD remains “under-recognized and undertreated,” according to a new study in Circulation. It concluded that most people with the disease are not getting the appropriate therapies—notably statins, aspirin and blood pressure drugs—which can be life-saving.
One of the main risk factors for PAD is smoking. A recent study in the Annals of Internal Medicine found that smoking increases the chances of developing symptomatic PAD by as much as 20-fold. Quitting smoking dramatically reduces the risk over time, but even after 10 or 20 years former smokers remain at somewhat elevated risk.
The other major risk factors are diabetes, high blood pressure, high cholesterol and obesity—as well as advanced age.
Pay Attention to Leg Pain
Many people dismiss leg pain as a normal sign of aging. You may think it’s arthritis, sciatica or just age-related stiffness. PAD pain feels different, however, since it’s felt in the muscles, not the joints.
If you have any kind of recurring leg pain, see your doctor. There’s a simple test for PAD called the ankle-brachial index, which is something like a standard blood pressure test.
So should all older people be screened for PAD? Only those with symptoms, or people who are at especially high risk for PAD, such as those with long-standing diabetes.
Bottom line: The same steps that help protect your heart and brain also reduce the risk of PAD—that is, maintaining healthy cholesterol and blood pressure levels, exercising, avoiding obesity and not smoking.