Peripheral Artery Disease and Your Heart

Arteries are found throughout our bodies. Acting as pipes, they carry nutrient- and oxygen-rich blood from the heart to organs, muscles, skin and other parts of the body.

Unfortunately, arteries can become stiff, narrowed and even blocked by a buildup of cholesterol and other substances — also known as plaque. This process is called atherosclerosis. It’s similar to when a pipe narrows or becomes blocked because of a buildup of debris. Blood flow slows, depriving muscles and other organs of oxygen and vital nutrients.

We typically think of atherosclerosis as affecting the heart’s arteries (called coronary artery disease), which can cause a heart attack or chest pain. But this process can occur anywhere in the body.

If you have peripheral artery disease (PAD), sometimes not enough blood flows to your arms and legs. Many people don’t have any symptoms at first, but as PAD progresses you may notice:

• Your legs feel very tired, heavy or start to cramp when you walk, and you might need to stop and rest
• Your walking speed becomes slower
• You have leg or foot pain, or both
• Ulcers or wounds that won’t heal

The main concern is that PAD also increases the chance of a fatal heart attack or stroke. Use this condition center to learn more about how PAD increases your risk — and how you can protect your heart.

Understand the Connection

Peripheral Artery Disease, also called PAD, isn’t limited to your limbs. For many patients, PAD can signal a greater tendency to deposit cholesterol (and develop atherosclerosis) in the arteries elsewhere in the body, including those supplying the heart and brain. That means you are more likely to have a heart attack or stroke.

Compared with people who have heart blockages only, people with PAD and CAD have more than twice the risk of cardiovascular-related death in one year.

Without good circulation:

• Muscles can ache, or become weak or tired
• Organs can be damaged and even fail (heart attack, stroke, kidney disease)
• Skin can become dry or pale and have wounds that don’t heal well

PAD is said to be a marker for systemic atherosclerosis, similar to cancer that has spread to other parts of the body. So if you have PAD, you likely have some degree of plaque buildup in other areas of circulation, such as your heart arteries or carotid arteries. Taking steps to protect your health and slow any further harm to your arteries can help.

Be an Advocate

Many people — even clinicians — aren’t aware of how closely linked PAD is with heart and cerebrovascular problems. Adding to the problem is that many people don’t even know they have PAD.

What You Can Do

If you think you have PAD and haven’t yet been diagnosed, ask to be evaluated:

• Don’t be shy, especially if you have a hard time keeping up with your peers, notice leg discomfort when walking or feel as though you’re slowing down. Many times, people dismiss signs of PAD as a normal part of the aging process.
• Talk with your health professional about a simple test called the ankle brachial index (ABI). For this test, your doctor will compare the blood pressure readings in your ankles and arms to help assess blood flow to your legs using an ultrasound machine.

If you’ve been diagnosed with PAD:

• Develop a plan with your health care providers. Talk about how to assess and protect your arteries, including those supplying your heart, brain and other vital organs. Often, lifestyle changes and medications can help slow the progression or treat risk factors that can make blockages worse.
• If you smoke, you’ll want to ask for help to quit.
• Make sure you receive appropriate testing. Studies show that only a small portion of patients are referred to a vascular specialist. This expert may order tests to find out whether circulation (blood flow) can be restored to the muscle and tissue as well as find ways to help you move better. Revascularization is a procedure that can work in some patients to open clogged arteries in the legs.
• Remember, it’s OK to ask for a second opinion.

Early Detection and Treatment Are Key

By finding PAD early on, you can help prevent or delay further damage to the blood vessels. You’ll also be able to take advantage of less invasive treatment options, including medical therapy, a supervised exercise program or both.

Treatments will depend on whether you have symptoms, and there may be other considerations, too. Overall, therapy is aimed at managing symptoms and preventing further atherosclerotic buildup and may include:

• Supervised exercise
• Medications (note that aspirin or statins may be recommended even if your cholesterol is normal because they help reduce inflammation in the blood vessels)
• Procedures or surgeries to open blocked or narrowed arteries
• In rare cases, amputation
• Clot-preventing therapies
• Other lifestyle changes

Keep Your Risk in Check

If you have peripheral artery disease, or PAD, there are a few things to keep in mind:

1. Complications of PAD aren’t limited to the affected limb. 

People living with PAD are at risk for worsening leg pain with exercise and even amputation(s) (loss of a limb) due to permanent tissue damage. This can happen because the skin was deprived of blood supply and vulnerable to injury.

If you have symptoms of PAD, it is likely that they will remain relatively stable for a time. However, the risk of having a heart attack or stroke will — perhaps silently — worsen.

2. Even if you have PAD, but no symptoms, it’s important to take care of your heart. 

Although you might not have symptoms, or if they are mild, you still need to pay attention to your heart. People with PAD have a higher chance of having a heart attack and stroke.

Lowering your overall cardiovascular risk is critical if you have PAD, and may include:

• Exercise therapy — a supervised exercise program during which you will be asked to walk to the point of moderate pain (claudication — leg pain during walking that is relieved by rest) then rest and repeat.
• Lifestyle changes, including daily (walking) exercise and eating a healthy diet
• Weight loss
• Not smoking
• Managing other health risk factors such as blood pressure, blood sugar and cholesterol

3. Know your overall risk for blocked arteries.

There are calculators that your health care team can use to estimate your risk of having a heart attack or stroke over a set period of time. It’s important to know your personal risk and to understand that it changes over time. This can help you and your doctor develop a plan to aggressively manage your risk factors — those things that make heart disease and stroke more likely.

4. If you smoke.

It’s not easy to kick the habit. But if you have PAD, you need to reach out and get the help and support you need to stop smoking. Why?

People who smoke are 2 to 6 times more likely to develop PAD, and the symptoms and complications tend to be worse. Smokers also tend to develop symptoms sooner, usually between 40 and 50 years old.

5. Ask questions. 

Talk with your health care team about PAD and cardiovascular disease, especially if you already have PAD or suspect you might have it. Here are some questions to help get you started:

• I’ve heard PAD can be a red flag for heart disease. Is that a concern for me?
• What steps can I take prevent or slow other arteries being affected?
• How will we know if other arteries in my body are affected?
• What tests do I need to assess my heart health and risk for stroke?
• How often should I have arterial testing done?
• What are the best treatment options for me?
• What are the signs and symptoms of heart disease or stroke?

Many PAD Cases are Undetected

While millions of Americans are living with peripheral artery disease (PAD), many don’t know it, which means they:

• Aren’t getting timely care
• Remain vulnerable to heart attacks, stroke or even early death — one study showed that nearly 2 out of 3 people with PAD also had evidence of narrowing or blockages in their heart’s arteries

There are many reasons why patients may not know they have PAD:

• Many patients with PAD don’t notice symptoms right away and even if they do they can be subtle.
• The minority of patients — only 1 in 10 — have the classic calf cramping with exercise that is thought of as the hallmark sign of PAD.
• Many people falsely think “slowing down” and not being able to walk as far as they used to do is simply part of getting older.
• Women tend to have less obvious symptoms than men.
• Some patients may not be active enough to get symptoms.
• Many symptoms can mimic other conditions (for example, back, knee or hip pain, arthritis)
• Having diabetes can mask symptoms, too, because the nerves in the extremities may be damaged and fail to send signals to the brain; therefore, legs will not ache or cramp, but may just feel tired or like they are going to give out.

Who’s at risk for PAD?

The American College of Cardiology and American Heart Association have established guidelines to help better identify people who might have PAD or be at risk of developing it. You are more likely to have PAD if you are 50 or older and have risk factors for atherosclerosis, including:

• High blood pressure
• High cholesterol
• History of smoking
• Diabetes

Other factors that make it more likely you have PAD include:

• Family history of PAD
• Other blockages in your arteries, such as coronary artery disease, carotid artery disease, previous heart attack or stroke