Questions & Answers
1. Why do blacks have a higher rate of PAD?
Blacks have a higher rate of PAD because of the prevalence of risk factors such as diabetes, hypertension, and smoking. Blacks are almost twice as likely as whites to have diabetes. Additionally, more than 40 percent of blacks in this country have hypertension as compared to roughly 30 percent of whites. Controlling blood sugar and blood pressure levels as well as stopping smoking are modifiable risk factors that can decrease the risk of PAD.
2. If a person has no symptoms of PAD, should he or she still be tested?
Symptoms generally dictate the need to test for PAD. The problem is that many people have no symptoms. In these cases, it is best to examine a person’s risk factors and medical history. Smokers who are African American and have diabetes are especially at high risk of PAD, and may benefit from screening. Tests for PAD include a noninvasive procedure called the ankle-brachial index that compares blood flow to the arms to blood flow to the legs. In some patients, invasive tests, such as an angiogram, may be indicated.
3. If a person has leg pain while walking, how can he or she tell if the pain is from PAD rather than arthritis or some other illness?
Pain related to PAD worsens with increased levels of activity, such as walking uphill or stair climbing, and subsides with a short rest. Arthritis pain is not always associated with activity, often leads to stiffness in the joints, and tends to subside over the course of the day.
4. Can PAD be treated effectively without surgery?
Treatment depends on a person’s symptoms. If a person’s condition improves with an exercise regimen or other lifestyle changes, surgery may not be indicated. Exercising can help build up collaterals, or extra areas of blood flow, that may help with the symptoms. However, rest pain and gangrene, or tissue death, are indicators of a significant blockage, and may require bypass surgery or angioplasty to improve the blood flow.
5. Why is smoking a risk factor for PAD?
Smoking damages the inner lining of the blood vessels, and worsens atherosclerosis, or hardening of the arteries, the principal cause of PAD.
6. Will lifestyle changes, such as exercise and healthy eating, cure PAD?
Adjusting modifiable risk factors like stopping smoking, exercising, healthy eating, and watching one’s glucose can help slow the progression of PAD. However, there is no cure for the disease.
7. In PAD, do you have leg pain only when walking or exercising?
The usual symptoms of PAD are pain in the calf when exercising or walking. In more severe cases, people may experience pain at rest or gangrene — worrisome signs that need immediate surgical evaluation.
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Selwyn O. Rogers Jr.,M.D.,M.PH.
Director, Center for Surgery
& Public Health
Chief, Division of Trauma,
Burns & Surgical Critical Care
Brigham & Women’s Hospital
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