Stay in Circulation Facts About Peripheral Arterial Disease (P.A.D.) A National Public Awareness Campaign from the P.A.D. Coalition and the National Heart, Lung, and Blood Institute Introduction This presentation will answer your key questions about P.A.D. with information about the various steps you can take to reduce your risk. As with any disease, the more you understand, the more likely you will be able to either prevent it or reach an early diagnosis and treatment to protect your health.  Take steps to learn about P.A.D. and stay in circulation longer to enjoy and live your life!

What is P.A.D.? Peripheral Arterial Disease (P.A.D.) is a common yet serious disease. P.A.D. occurs when extra cholesterol and fat circulating in the blood collects in the walls of the arteries that supply blood to your limbs. P.A.D. can affect your quality of life, make walking difficult, or worse, increase your risk of heart attack, stroke, leg amputation, and even death. Occurs when… P.A.D. is most commonly seen when the arteries of your legs become hardened and clogged and reduce the flow of blood to your legs and feet. However, P.A.D. also can develop in the arteries that carry blood from your heart to your head, arms, kidneys, and stomach. Just like clogged arteries in the your heart, clogged arteries in you legs raises your risk for having a heart attach or stroke. P.A.D. can affect your quality of life… Nearly everyone who has P.A.D.-- even those that do not report leg symptoms– suffers from an impaired ability to walk as fast or as far as they could without P.A.D. The good news is that you can lower your risk for P.A.D.

Why should you learn about P.A.D.? P.A.D. affects 8 to 12 million people within the U.S., especially those over age 50. Early diagnosis and treatment of P.A.D. can help to… Prevent disability and restore your mobility Stop the disease from progressing Lower your risk for heart attack, heart disease, and stroke People who are at risk for P.A.D. include anyone over the age of 50, especially African Americans; those who smoke or have smoked; those who have diabetes, high blood pressure, high cholesterol or a personal or family history of vascular disease, heart attack, or stroke.

How do you know if you have P.A.D.? Most people with P.A.D. do not have the typical signs and symptoms of the disease. People who do experience symptoms often fail to report them because they think they are a natural part of aging. P.A.D. does not always present symptoms or cause pain. In fact, many of those with P.A.D. do not have the typical signs and symptoms of the disease

What are the signs and symptoms of P.A.D.? Claudication—fatigue, heaviness, tiredness, cramping in the leg muscles (buttocks, thigh, or calf) that occurs during activities such as walking or climbing stairs The pain or discomfort goes away once the activity is stopped or during rest. Claudication- What is it? Many people fail to report this problem to their health care providers because they think it is a natural part of aging or due to some other cause.

More signs and symptoms of P.A.D. Cramping or pain in the legs and/or feet at rest that often disturbs sleep Sores or wounds on toes, feet, or legs that heal slowly, poorly, or not at all Color changes in the skin of the feet, including paleness or blueness A lower temperature in one leg compared to the other leg Poor nail growth and decreased hair growth on toes and legs

What causes P.A.D.? Plaque builds up on artery walls, blocking flow of blood to the arteries of the limbs, often the legs. The cause of plaque buildup is unknown in most cases. However, there are some conditions and habits that raise your chance of developing P.A.D.

Are you at risk for P.A.D.? Are you over age 50? Do you smoke or used to smoke? Do you have diabetes? Do you have high blood pressure? Do you have high blood cholesterol? Do you have a personal history of vascular disease, heart attack, or stroke? Are you African American? Those who smoke or have a history of smoking have a four-times greater risk of P.A.D. One in every three people over age 50 with diabetes is likely to have P.A.D. Also called hypertension, high blood pressure raises the risk of developing plaque in the arteries Excess cholesterol and fat in the blood contribute to the formation of plaque in the arteries, reducing or blocking blood flow to your heart, brain, or limbs. If you have heart disease, you have a one in three chance of also having P.A.D. African Americans are more than twice as likely to have P.A.D. than their non-Hispanic, white counterparts.

At risk for P.A.D.? Then… Discuss this concern with your health care provider. Ask your health care provider if you should be screened or tested for P.A.D. Reiterate: Even though the classic symptoms of P.A.D. may not be present, everyone who has P.A.D. is at higher risk for a heart attack, heart disease, and stroke than those without P.A.D.

Think you may be at risk? Ask your health care provider… Does my medical history put me at higher risk for P.A.D.? Which screening tests or exams are right for me? If I have P.A.D., what steps should I take to treat it? What steps can I take to reduce my risk for heart attack and stroke?

More questions for your health care provider… What is my blood sugar level? If I have diabetes, what should I do about it? What is my blood pressure? Do I need to do anything about it? What are my cholesterol numbers? Do I need to do anything about them? What can I do to quit smoking? Cholesterol numbers These include total cholesterol, LDL, HDL, and triglycerides—a type of fat found in the blood and food.)

Health care providers use a variety of methods to diagnose P.A.D. Medical and family history Physical exam Diagnostic tests Ankle-brachial index (ABI) Doppler ultrasound Other tests When looking for P.A.D., health care providers will usually: Review a patient's medical and family history; Conduct a physical exam, checking Pulses in the legs and feet The color, temperature, and appearance of the legs or feet Signs of poor wound healing on the legs and feet, and Perform diagnostic tests, including The ankle-brachial index, or ABI. This non-invasive and painless test compares the blood pressure readings in the ankles with the blood pressure readings in the arms to determine if P.A.D. is present. Other diagnostic tests that a health care provider may use include a Doppler ultrasound test, which measures blood flow in the veins and arteries in the limbs; and blood tests, to check for diabetes and cholesterol levels. 12

The First Tool to Establish the PAD Diagnosis: A Standardized Physical Examination Pulse assessment 0 = absent 1 = weak 2 = present (easily found) 13

ABI Procedure = Ankle/Brachial Index http://www.nhlbi.nih.gov/health/dci/Diseases/pad/pad_diagnosis.html 14 14

The overall goals for treating P.A.D. Reducing the risk for heart attack and stroke Reducing any symptoms Improving quality of life and mobility 15

Two main treatment approaches Reduce cardiovascular risk Get help to quit smoking Lower blood pressure Lower LDL (bad) cholesterol Manage diabetes Take anti-platelet medicines such as aspirin or clopidogrel Follow a healthy eating plan 16

Two main treatment approaches Relieve leg pain symptoms Get regular exercise Special PAD exercise program Medicines are available to improve walking ability Special procedures or surgery, if needed 17

How can I reduce my risk for P.A.D.? Don’t smoke/quit smoking. If you have diabetes, high blood pressure, and/or high cholesterol, talk to your health care provider about how to manage your condition. Eat a healthy diet full of fruits, vegetables, and whole grains. Be active for 30 minutes a day. Do not smoke. If you need help quitting, ask your health care provider for assistance in developing a smoking cessation plan. If you have diabetes, high blood pressure, and/or high cholesterol, talk to your health care provider about the steps you can take to manage your condition. Maintain a healthy weight by eating healthy and getting at least 30 minutes of physical activity on most days. Most health care providers recommend a diet that is low in saturated fat and cholesterol and high in fruits, vegetables, and whole grains. Ask your health care provider about a supervised weight loss treatment plan if you are overweight or obese.

To Learn More about P.A.D. Visit: P.A.D. Coalition www.PADCoalition.org Vascular Disease Foundation www.vdf.org Stay in Circulation www.aboutpad.org