Don’t Jump To Occlusions

Peripheral artery disease (PAD) is among the most underdiagnosed, untreated and potentially deadly conditions people can face, raising the risk of heart attack and stroke. An aging population and an increase in obesity and diabetes are causing a wave of non-cardiac vascular disease, affecting as many as eight million people. Canadian cardiologists learned that five percent of the adults over fifty who were screened for PAD had it, but an astounding 80% were unaware of it. Those pains and cramps you feel in your legs when you climb the stairs or simply walk down the driveway to get the mail might be more than you think.

Only about a fourth of the over-fifty group is aware of PAD. That’s the group most likely to be affected by it. PAD can be identified by comparing blood pressure in the arm to the blood pressure in the leg. Those who have already suffered a heart attack or stroke are at the highest risk, and need to be screened at least once a year. Dr. Ross Tsuyuki, of Canada’s U. of Alberta, adds that, “The second highest priority would be people middle-aged and beyond who are at risk for heart disease and stroke, such as people with high blood pressure, diabetes and high cholesterol.”  Besides leg pain, other PAD symptoms include leg sores that are slow to heal, toe pain in the evening, and a sensation of coldness or numbness in one or both legs. Dr. Peter Hibberd contributed that, “The secret to treatment is first-line prevention by avoiding…cigarettes and reducing risk factors for vascular disease (such as lipid disorders) as much as possible as early as possible.”  (Scaglione. Newsmax Health. 2011)  (Makowsky. 2011)

Rapidly evolving vascular technologies have introduced non-invasive, cutting-edge procedures for treating PAD. Interest in screening for non-cardiac vascular disease has also grown since preventive approaches to medicine are on the upswing. One of the latest treatments, although somewhat invasive, is the use of the patient’s own stem cells to make new blood vessels to replace or to augment those choked off by plaque buildup. (Society for Interventional Radiology. 2010)

A person at risk for PAD might consider dietary interventions to help manage contributing factors. Increasing fruits and vegetables, and decreasing empty calories can help to attenuate the accumulation of arterial fat deposits. Of course, drug treatments abound. Cholesterol drugs, blood pressure drugs, blood sugar drugs, anti-blood clot drugs, and symptom-relief drugs are at your doctor’s fingertips…or pen point. On the other hand, there is a body of research to support alternative measures to address PAD, as you’ll see in a minute.

Mortality in patients with recognized coronary artery disease (CAD) and PAD is unsurprisingly high, but therapy can mitigate that. Maintenance of normal weight is an important step, and keeping the body mass index lower than 25.0 is vital, even for those who have never smoked. (Ix. 2011)  Research has shown that a greater BMI will intensify PAD symptoms as evidenced by a decline in walking velocity and performance. (McDermott. 2006)  In cases such as this, supervised exercise training and education provide significant benefits in quality of life and reduced risk for cardiovascular episodes. (Casillas. 2011)

European medicine is supportive of complementary and alternative approaches to the healing arts, so it comes as no surprise that a considerable level of research starts there. German studies have used ginkgo biloba in PAD trials that date back to the late 90’s, finding that efficacy of the herb is dose-dependent, with 240 mg a day superior to the standard dose of half that. (Schweizer. 1999)  (Li. 1998) The British agree that ginkgo is better than placebo in treating the intermittent claudication that accompanies PAD. (Pittler. 2000)    Besides ginkgo, L-arginine, the amino acid that tells blood vessels to relax via the manufacture of nitric oxide, has shown benefits in handling intermittent claudication of PAD (Boger. 1998)  Nitric oxide inhibits contractions of vascular smooth muscle and keeps the blood flowing while helping to sustain blood pressure. There is some evidence that arginine improves the management of multiple CVD indications. (Cheng. 2001)

It might be comforting to know that alternatives to drugs for PAD exist, but it is prudent to look at diet, exercise, and lifestyle before heading to the supplement aisle.

Donna V. Scaglione Peripheral Artery Disease: More Than Just an Ache www.newsmaxhealth.com/headline_health/Peripheral_Artery_Disease/2011/09/15/407320.html Thursday, September 15, 2011 1:08 PM

Makowsky M, McMurtry MS, Elton T, Rosenthal M, Gunther M, Percy M, Wong K, Fok J, Sebastianski M, Tsuyuki R. Prevalence and treatment patterns of lower extremity peripheral arterial disease among patients at risk in ambulatory health settings. Can J Cardiol. 2011 May-Jun;27(3):389.e11-8.

Society for Interventional Radiology. 16 March 2010 Stem cells build new blood vessels to treat peripheral arterial disease http://www.sirweb.org/news/newsPDF/92_stem_cells_final.pdf

Ix JH, Biggs ML, Kizer JR, Mukamal KJ, Djousse L, Zieman SJ, de Boer IH, Nelson TL, Newman AB, Criqui MH, Siscovick DS. Association of Body Mass Index With Peripheral Arterial Disease in Older Adults: The Cardiovascular Health Study. Am J Epidemiol. 2011 Sep 13.

McDermott MM, Criqui MH, Ferrucci L, Guralnik JM, Tian L, Liu K, Greenland P, Tan J, Schneider JR, Clark E, Pearce WH. Obesity, weight change, and functional decline in peripheral arterial disease. J Vasc Surg. 2006 Jun;43(6):1198-204.

Casillas JM, Troisgros O, Hannequin A, Gremeaux V, Ader P, Rapin A, Laurent Y. Rehabilitation in patients with peripheral arterial disease. Ann Phys Rehabil Med. 2011 Aug 5.

Schweizer J, Hautmann C. Comparison of two dosages of ginkgo biloba extract EGb 761 in patients with peripheral arterial occlusive disease Fontaine's stage IIb. A randomised, double-blind, multicentric clinical trial. Arzneimittelforschung. 1999 Nov;49(11):900-4.

Li AL, Shi YD, Landsmann B, Schanowski-Bouvier P, Dikta G, Bauer U, Artmann GM. Hemorheology and walking of peripheral arterial occlusive diseases patients during treatment with Ginkgo biloba extract. Zhongguo Yao Li Xue Bao. 1998 Sep;19(5):417-21.

Pittler MH, Ernst E. Ginkgo biloba extract for the treatment of intermittent claudication: a meta-analysis of randomized trials. Am J Med. 2000 Mar;108(4):276-81.

Böger RH, Bode-Böger SM, Thiele W, Creutzig A, Alexander K, Frölich JC. Restoring vascular nitric oxide formation by L-arginine improves the symptoms of intermittent claudication in patients with peripheral arterial occlusive disease. J Am Coll Cardiol. 1998 Nov;32(5):1336-44.

Cheng JW, Baldwin SN. L-arginine in the management of cardiovascular diseases Ann Pharmacother. 2001 Jun;35(6):755-64.