Lifestyle Changes Found Critical in Fighting Peripheral Arterial Disease

Modifying the risk of peripheral arterial disease (or PAD) with healthy lifestyle changes is of major importance in disease management, according to a new study.

Researchers at Beaumont Hospital (Dublin, Ireland) and an at Northwestern Memorial Hospital (Chicago, IL, USA) retrospectively evaluated 918 patients at Beaumont Hospital who underwent peripheral angiography with or without angioplasty between January 1999 and June 2006; of these, 122 patients (54% men; mean age 70.3 years) who had angiographic stenoses or occlusions on the asymptomatic leg, but without any corresponding leg symptoms, were included in the follow-up to determine if they developed any symptoms and to see if they required any treatment for their PAD in the form of angioplasty, stenting, surgical bypass or amputation. The composite endpoint was major adverse clinical outcome (MACO) of the asymptomatic limb at clinical follow-up, which was defined as the development of intermittent claudication (IC), critical limb ischemia (CLI), or need for subsequent endovascular or surgical revascularization.

The researchers found that one-third of the 122 patients developed symptoms of pain or ulceration, and almost half of these then required treatment. Overall, only 13.9% of the initial group required treatment, so that even though PAD progressed over time, the researchers did not believe they had enough evidence to advocate early minimally invasive treatment of PAD in patients who had no initial symptoms. The study was published in the September 2009 issue of the Journal of Vascular and Interventional Radiology.

"While this study is useful in examining the possibility of treating PAD earlier, additional research into the factors that cause PAD progression and the rate of progression, along with methods to slow the disease, need to be conducted,” said lead author interventional radiologist Aoife Keeling, M.D., of Northwestern Memorial. "Prevention of PAD progression is vital and can be achieved with risk factor modification, for example, if individuals stop smoking, watch their diets, lower their cholesterol and have their blood pressure monitored.”

PAD occurs when plaque accumulates in arteries that supply blood to areas of the body other than the heart and brain. Since plaque blocks the leg arteries first, PAD is considered a red flag for several life-threatening vascular diseases, such as heart attack and stroke. PAD causes a range of symptoms, from no symptoms to pain in the legs while walking (IC), to its most severe form that results in pain in the feet and legs at rest that can progress to ulcers and eventual gangrene (critical limb ischemia). The disease's progression can result in limb loss and even in death.

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Beaumont Hospital
Northwestern Memorial Hospital