Angina in the legs? Time to alert patients and physicians

It contributes to thousands of deaths every year yet nobody knows for sure how many Canadians have PAD.

"PAD is under diagnosed and under treated," Heart and Stroke Foundation researcher Dr. Ross Tsuyuki told the Canadian Cardiovascular Congress 2009, co-hosted by the Heart and Stroke Foundation and the Canadian Cardiovascular Society.

"PAD is caused by a narrowing of the arteries that supply blood to the legs. The pain some PAD patients experience is the lower limb equivalent of the chest pain from the heart," says Dr. Tsuyuki. Since the leg artery narrowings seen in PAD usually imply similar narrowings in heart and brain arteries, PAD is a strong marker for heart disease and stroke.

"PAD is as serious as heart disease and its prevention and treatment is similar," says Dr. Tsuyuki. "It's unique in that it manifests in the legs but is just as urgent."

He warns that the index of suspicion for family doctors should be high, however often it's not. Many people with PAD have no, or very mild, symptoms. Only about half of people experience pain walking. Once the diagnosis of PAD has been made, physicians should also consider if significant artery narrowings are present in the heart and brain.

Dr. Tsuyuki and his team at the University of Alberta sought answers by studying 362 volunteers over age 50, chosen from 10 pharmacies in Central and Northern Alberta and in physician offices. After extensive screening and testing, the results found 17 PAD cases, a prevalence of five per cent.

Importantly, 80 per cent of the people diagnosed with PAD were previously unaware they had this condition. This is important because knowledge of the presence of PAD mandates more aggressive treatment, not only to treat leg symptoms, but also prevent heart attacks and strokes.

"These figures emphasize the importance of PAD screening to detect disease and guide treatment," says Dr. Tsuyuki. "The study also points to the value of community pharmacies as an efficient way to screen for this condition."

The researchers followed up with the people diagnosed with PAD three months after the screening and found that 88 per cent visited their family physician following the screening and half then received lifestyle or pharmacologic interventions.

Screening for PAD is a simple procedure that compares the blood pressure in the leg to that of the arm. A ratio of leg pressure to arm is less than 0.90 indicates the presence of PAD.

Heart and Stroke Foundation spokesperson Dr. Beth Abramson says that physicians should aggressively treat any high blood pressure and cholesterol in their patients with PAD and manage diabetes if it is present. "People don't recognize that leg cramps while walking may be due to circulation problems that put them at risk for heart disease and stroke," she says.

Dr. Abramson says people should talk to their doctor if they have difficulty with walking and develop pain or discomfort in the calves or legs that get better with rest. "This symptom - called claudication - is angina in the legs and puts you at risk of heart attack."

She says that heart attacks are often due to disease resulting from narrowing of arteries of the heart and that people should be aware that this disease can be widespread throughout the body. "If we see narrowing of the arteries in the legs, it's often in the heart as well, hence the heart/leg connection."

While PAD may have no symptoms, here are some signs and symptoms to look for:

• Leg pain during exercise (most common symptom).
  
• Open sores that don't heal.
  
• Feeling of coldness or numbness in one or both legs.
  
• Pain in the toes at night.

You are at higher risk of developing PAD if you:

• Smoke or previously smoked.
  
• Have diabetes.
  
• Have high blood pressure.
  
• Have high blood cholesterol.
  
• Have heart disease or have had a stroke.

By being physically active and smoke-free, PAD patients can reduce their symptoms, improve their mobility and quality of life, and potentially prevent heart disease and stroke.

Source: Heart and Stroke Foundation of Canada