It’s Time To Care About PAD
By Dr. Mark Creager, Immediate Past-President, American Heart Association
Last year, I addressed the scientists and health leaders who attended the American Heart Association’s Scientific Sessions and the topic of my speech was one that is close to my work as a specialist in vascular medicine and also my heart – my father had PAD. This month is Peripheral Artery Disease Awareness Month and I wanted to share with you why PAD is such a pressing issue for all of us.
The importance of the vascular system was noted by Hippocrates, when he made this observation about the blood vessels: “They are the sources of human nature and are like rivers that purl through the body and supply the human body with life.” It is a compelling metaphor. Rivers are sources of life, vitality, and connectivity. When a river becomes obstructed or damaged, everything around it suffers, sometimes with grave consequences. The same occurs with the rivers and tributaries that are our blood vessels. When they are damaged, everything downstream is in peril. That is precisely the problem millions of Americans are facing today—their damaged vessels put their bodies in dire jeopardy.
Today, two significant vascular disorders, atherosclerosis and thrombosis, are the principal underpinnings of the two leading causes of death in the world: heart disease and stroke. These disorders also cause peripheral artery disease (PAD), which affects between 8 and 10 million people in the United States.
PAD limits a person’s ability to walk, may require revascularization, or worse yet, can result in the loss of a limb. But PAD is not simply a disease of the legs. It is a clinical manifestation of a systemic disease, often associated with heart attacks, strokes, life-threatening kidney and intestinal problems, and other serious health issues. Tragic outcomes can also occur when veins are affected. Up to 600,000 people are affected by venous thromboembolism each year, and it is the cause of more than 40,000 deaths.
The burden of vascular diseases goes beyond lives lost and changed. Costs in this country for vascular-related complications in patients with PAD is more than $20 billion a year.
And PAD is not just a problem in the U.S. – low-, middle- and high-income countries see prevalence – more than 200 million people are living with PAD worldwide. The risk of PAD is increased by tobacco use, diabetes mellitus, and high cholesterol, and prevalence increases dramatically as we age. PAD is also disproportionately present in some minority populations. For example, there is a greater prevalence in black people than white people, which is consistent with the troubling fact that black people face an overall higher burden of heart disease and stroke.
Socioeconomic factors play an important role with PAD. When my colleague Reena Pande and I investigated the U.S. National Health and Nutrition Examination Survey (NHANES) database, we found the highest prevalence among people in the lowest income brackets or with the lowest education levels. These findings were largely independent of traditional risk factors.
Why is this important? Because the risk of death is at least doubled in comparison with patients who do not have PAD. And the risk of cardiovascular death, myocardial infarction, stroke, and hospitalization among people with PAD exceeds that of patients who already have had a heart attack or established cerebrovascular disease. Yet PAD is a health crisis that is largely unnoticed.
One survey found that 75% of the public is unaware of PAD.
Even physicians often fail to consider PAD, chalking up leg pain to age or arthritis. In 1 study, physicians missed the diagnosis of PAD half the time.
But, as we educate people about their risks and train healthcare workers on proper diagnosis and treatment of PAD, and as we work to change our health on a larger scale – we are making a difference. Our ability to diagnose and treat vascular diseases has never been greater. The field of vascular biology has virtually exploded in recent years. Our understanding of the pathophysiology underlying atherosclerosis and thrombosis is being translated into novel therapies for prevention and treatment.
I’ll end with the story of one of my middle-aged patients, who – along with other forms of treatment - was putting in 30 minutes a day on the treadmill and doing quite well. Her conditioning improved so much that she was able to spend 6 hours per day over several days at Disney World in Orlando with her 5-year-old granddaughter. In a letter to me afterward, she called it “the most wonderful vacation of my life.” She said “the joy of seeing my granddaughter’s face light up…was well worth all the hours I have spent exercising.” She summed it up by saying, “Thank you for giving me back the will to continue walking.” It was one of those moments we are all grateful for—when we see our work change people’s lives. It is moments like those that underscore our need to address vascular diseases.