By J. Manuel Cordova, M. D.t
Peripherical Vascular Disease
“The Phantom Killer”
In the previous article, I said: there are some risk factors around this disorder, Smoking is the greatest risk factor for developing Peripheral artery disease PAD. A half a pack a day habit can increase the risk by 30% to 50%. Those with a family history of the disease or who have high blood pressure or high cholesterol are also more likely to develop PAD. While it is most common among people over 50 and smokers, PAD can strike non-smokers and young adults as well.
A number of efforts are underway to raise awareness, and screen patients who are at risk and investigate the most cost- effective treatments, including exercise programs that have shown to help control the disease.
Several researches and groups are lobbying the federal government to make a screening test for PAD more widely available. Actually, Medicare will cover it only for patients who already show symptoms of PAD. The Peripheral Artery Disease Coalition of more than 50 organizations endorses a specific test called ABI— Screening and is lobbying the Federal Preventive Services Task Force to review this Test (ABI) with the aim of getting it covered more widely by Medicare. About 10% of PAD patients have a severe form of leg pain, known as claudication. Caused by inadequate blood flow, it typically occurs while walking or climbing stairs and stops at rest. Half of the patients may have other leg symptoms such as heaviness, fatigue and cramps. The first line of treatment for PAD is daily exercise and a healthy diet. Medications are also often used, including statins to lower cholesterol, blood thinners, blood-pressure medications.
A growing number of patients are also getting invasive procedures such as angioplasty with stents. About 529,000 leg stents were placed last year in the US alone, up from 386,000 five years ago. There are, however, issues with using stents in the legs. Blockages in the legs tend to be longer and more spread out than those in coronary arteries. And stents in the legs may fail and require replacement. Bypass surgery similar to that performed on coronary arteries is also used in severe cases and can help avoid amputation, by using another vein or a synthetic graft to reroute blood around the diseased artery, but complications are more common than with coronary artery bypass.
Several studies are aiming to identify the most effective types of exercise to treat PAD. Researchers have found that supervised training is significantly more effective than simply giving patients instructions to take up walking at home.
A new study funded by the National Heart Lung and Blood Institute is comparing the effectiveness of three approaches: 1. Supervised exercise therapy, 2. Exercise at home with a drug to decrease leg pain, and 3. The placement of a stent. Known as the Clever Study—an acronym for Claudication Exercise vs. Endoluminal Revascularization—it is recruiting participants at www.cleverstudy.org.
Dr. Hirsch, one of the investigators, says one aim is to see if the high costs of invasive procedures can be reduced with “structured exercise” and simply giving patients instructions to take up walking at home. The situation will be simple: Walking is the key!