Calling it a silent killer may seem melodramatic, but it isn’t an exaggeration. Peripheral arterial disease (PAD) affects about five per cent of Canadians, yet goes largely undetected. A narrowing or clogging of the arteries in the legs, PAD puts people at a six times greater risk of stroke or heart attack and is therefore as serious a risk factor for these events as clogged arteries in the heart.
Common symptoms of PAD include fatigue or pain in the legs, thighs or buttocks that occurs during walking and stops after walking; foot or toe pain that disturbs sleep; and skin wounds or ulcers on feet and toes.
“It’s a disease that’s under the radar screen,” says Dr. Beth Abramson, a cardiologist at St. Michael’s Hospital in Toronto.
The problem is that PAD tends to occur in older people who may have several other health problems that take up their doctor’s attention. In fact, people may not even bother going to the doctor for a leg cramp, says Abramson, but they need to realize that “it’s not that they’re at risk of a leg attack, but that they’re at risk of a heart attack.”
Dr. André Roussin, who helped write Canadian guidelines on PAD and is chairman of the Thrombosis Interest Group of Canada, says because PAD often causes no symptoms, doctors should check men over the age of 40, postmenopausal women over the age of 50, and any patients with cardiovascular risk factors, which include age, family history, elevated cholesterol levels, smoking, high blood pressure, diabetes and obesity.
To check for PAD, doctors may ask about leg pain and check the pulses in the feet. But Roussin says many doctors may not be performing this simple examination because they may not know how or may not be aware of PAD or how serious it is. “When you don’t know, you don’t see the disease. You only focus on heart disease, on stroke, and you forget that peripheral arterial disease is just as bad a marker of death as (a heart attack).”
People with PAD risk factors can lower their risk by quitting smoking, participating in a supervised exercise program, taking medication to lower cholesterol and blood pressure, and managing high blood sugar through diet or medication. Those who already have the condition need to take blood-thinning medication.