Increasingly, doctors are becoming aware of the danger inherent in peripheral artery disease and its effect on individuals over 55. Sufferers have a greatly increased risk of heart attack or stroke, and of dying within a decade. Yet, two-thirds of those afflicted do not know they have it because they display no symptoms.

Caregivers need to be especially sensitive to this situation as loved ones get older and less mobile. They need to separate a natural slowing down in activity due to aging from the symptoms of advancing arterial decay. This report also indicated that caregivers should be particularly concerned for older individuals who are less mobile and outward manifestations such as ulcers and complaints about leg cramps and muscle aches.

A recent issue of the journal, Archives of Internal Medicine, carried a “call to action” to increase awareness of the problem among doctors and the public. In the United States, the disease is estimated to cost $151 billion in direct and indirect expenditures over a five-year period.

Peripheral artery disease results from a buildup of fat-laden gunk on artery walls, or atherosclerosis. When blood is forced through the narrowed arteries, less oxygen reaches the leg muscles. This leads to a painful condition called intermittent claudication. When this situation involves arteries to the heart, it is called angina.

The authors of the study say that if arteries in the legs are narrowed, than it is probably that a similar situation is happening to the heart. Therefore, a higher incidence of heart attack and stroke may occur.

Among the other warning signs associated with peripheral artery disease are discoloration of the legs or feet, foot ulcers that fail to heal or legs that swell and become numb or cold or feel tingly.

Leading risk factors increasing the chances of developing the condition include smoking, diabetes and advanced age. Other factors include high blood pressure, obesity, elevated blood levels of cholesterol, homocysteine, fibrinogen or glucose and a history of heart attack or stroke.

The physicians, led by Dr. Jill F. Belch, professor of vascular medicine at the University of Dundee in Scotland, believe that relying solely on symptoms of intermittent claudication is not enough. They recommend a 20-minute screen test called A.B.I, or ankle-brachial index. It uses ultra-sound to measure blood flow in the leg above the ankle. (for a description of the test see the attached box)

Among the drugs used in treatment of patients with established peripheral artery disease are antiplatelet agents (low dose aspirin), clopidogrel (Plavix), pentpxofylline (Trental) and cilostazol (Pletal).

Doctors suggest exercise training to improve heart function and foster the development of additional blood vessels. Using a treadmill in a supervised training program over three months can be very effective suggests physicians studying this problem.

Comments on these findings were made in the Archives of Internal Medicine by Dr. Jonathan L. Halpern and Dr. Valentin Fuster of Mt. Sinai Hospital in New York City. To reach them go to the hospital’s website for further information www.mssm.edu or www.mountsinai.org.

The Archives of Internal Medicine is on the web at http://www.ama-assn.org/go/internal (new web address).