Peripheral Arterial Disease
Peripheral arterial disease (PAD), also known as peripheral artery or peripheral vascular disease, is a condition which is characterised by a build up of fatty tissues (Atheroma) on the inside wall of various arteries throughout the body. It is closely linked to Atherosclerosis and Coronary Heart Disease.
Although it can potentially affect any artery, when it occurs in the legs it is known by this unique term.
What causes Peripheral Artery Disease ?
The condition is usually related to Atherosclerosis. The accumulation of the Atheroma causes symptoms of blocked arteries in the legs due to the plaque build-up. This is turn restricts the flow of blood to the legs, and results in a shortage of oxygen and nutrient rich blood to supply the muscles of the leg when walking or running.
Atheroma can also affect the coronary arteries, where it can cause angina or a heart artery blockage. This can cause a heart attack or sudden cardiac arrest. When it affects the arteries that supply the brain, it can cause a brain stroke.
Symptoms of PAD
Up to half the people who have leg circulation problems, or peripheral artery disease are unaware that they have the condition.
The primary blocked artery symptoms are pain or discomfort in the legs or lower limbs when exercising, walking or running, as the muscle fed by the affected artery starts to work harder and requires more blood supply. Stopping the activity may cause the pain to subside, and this is an additional indicator for the condition. This type of temporary pain is known as ‘intermittent claudication’.
In severe cases, the pain may be felt like a squeezing of the muscle which forces the sufferer to rest until it lapses. Other symptoms may include :-
* Aching or cramping of the leg muscles
* Numbness or exhaustion of the leg muscles
* pain in the thigh or buttock
* difficulty in walking, or walking more slowly than normal
* Restricted walking distance
* Numb or cold feet and toes
* Loss of hair from legs or feet
Risk Factors
Atheroma can build up for many years before it causes problems.
Smoking is the greatest risk factor for PAD and Atherosclerosis, and artery restriction is believed to start within months for people who smoke cigarettes.
Other contributory factors are high blood pressure, high blood cholesterol levels, diabetes, poor diet, and lack of exercise. These all contribute to the development of Atherosclerosis. Being male and aged over 50 years also increases the risk.
People with peripheral arterial disease are at much greater risk of having a heart attack or a stroke. This is due to the high probability that other arteries in their body are also clogged with excess blood lipids, and arterial deposits of plaque.
Treatments for Peripheral Arterial Disease
Treatment will usually depend on the severity of the condition, and the Doctor will aim to improve the patients ability to walk without pain, and reduce the risk of further damage to the arteries. By tackling the more serious underlying causes, this can avoid the possibility of future life threatening complications such as heart attack and brain stroke.
Lifestyle Treatment
If the condition is in it’s early stages the treatment will usually aim to consist of daily exercise to improve the circulation and unclog arteries. This may involve switching to a low fat diet that is rich in fruit and vegetables with high concentrations of the antioxidant vitamins C and E. Aspirin may also be prescribed as it helps to thin the blood and prevent the formation of blood clots. Certain herbs such as Gingko biloba or a combination of Tibetan herbs have been shown to increase the distance sufferers can walk before they experience pain.
Medication
For more advanced cases medicines may be used to control the effects of the clogged arteries. If you have a high cholesterol level, you may be given a type of drug called a statin. If you have diabetes, your doctor will ensure that your diabetes is under control and being correctly managed. If you have high blood pressure, you will be given medication to treat this.
You may also be given an anti-platelet drug. These drugs prevent blood clots from forming, which can lead to coronary artery blockage, heart attack and stroke. Anti-platelet drugs include clopidogrel and aspirin.
Surgical Options for Peripheral Artery Disease
Surgical intervention is carried out by a vascular surgeon and is usually reserved for serious cases, or those that have not responded to other forms of treatment.
Angioplasty is a type of surgical procedure to relieve the symptoms of a clogged artery, where the narrowed part of the leg artery is widened by inflating a small balloon internally within the artery. The Angioplasty balloon is later removed leaving the artery wider, and able to pass an increased blood flow to the affected part of the leg.
Where the narrowing of the artery is more extensive, it may be necessary to bypass a section of it by using a replacement – either a vein from the leg or a synthetic replacement material.
In severe cases, when the blood supply cannot be restored to a limb it may have to be amputated.
Coronary Heart Disease Causes
Coronary heart disease definition (CHD)
A common question we receive is ‘what is coronary heart disease’? CHD may be summarised by what happens when your heart’s blood supply is blocked, or interrupted, by a build-up of fatty substances in the coronary arteries. These deposits can cause the walls of your arteries to become coated (or furred up), which is known as atherosclerosis. If your coronary arteries – the ones which feed the heart – are narrowed, then the blood supply to your heart will be restricted. This can cause pain in the chest, or angina.
If a coronary artery becomes completely blocked, it can cause a heart attack, or to quote the correct medical term – a myocardial infarction.
Coronary heart disease facts
It is important to consider that healthcare professionals are usually only involved when heart disease becomes evident, and sometimes this can be too late. So, overwhelmingly, prevention is better than cure. The following coronary heart disease statistics can be very sobering :-
- Heart disease affects nearly 1 million people in the United Kingdom
- Heart disease kills more than 110,000 people each year in the United Kingdom
- 40 percent of patients who die of a heart attack have no prior warning
- 50 percent of heart attack deaths occur in the first two hours following the attack
- Doctors and heart specialists typically see less than 5 percent of patients who die after a sudden heart attack
A relatively new illness?
Coronary heart disease has only been recognised as a major disease for about a hundred years. In the last few decades we have seen major scientific advances in its diagnosis and treatment through drugs and surgical procedures which has resulted in thousands of lives being saved.
However despite all this progress, worldwide heart disease statistics indicate that heart disease is still increasing dramatically.
Coronary heart disease develops in the arteries over a long period of time. However it is possible to personally influence whether this terrible dread disease will take a hold over your life or not.
Previous generations had much simpler lives
It is very obvious that our ancestors lead very different lives from us. In order to feed themselves, they had to use a lot of physical energy to hunt, or manually farm their food. The type of food they ate largely consisted of vegetables, fruit and nuts with some fish or meat if they had a lucky break on the previous hunting trip.
The way the food was cooked also differed – it would usually have been cooked in a hurry over an open fire, rather than refined and over-cooked, thus losing much nutritional value. But most importantly the pre-historic diet was extremely low in fat. We could refer to this as the perfect ‘anti’ coronary heart disease diet.
Compare that with the modern lifestyle – consumption of high quantities of highly refined processed foods that are also high in saturated fat, salt and sugar. Combined with sedentary or inactive lifestyles with insufficient physical activity and exercise - you have a recipe for illness and disease.
Excessive fat consumption puts a strain on the liver, which is responsible for maintaining the correct level of cholesterol within the body. The excessive fat consumption associated with the modern western diet causes the liver to ‘overflow’ it’s capacity to remove surplus ‘low density molecules’ which are high in ‘bad’ or ‘LDL’ cholesterol lipoproteins.
The human genome project has provided us with some incredible science regarding our genetic make-up. There is good scientific evidence that the human genetic footprint requires a diet and lifestyle that is closer to the pre-historic variety than the modern variety. So it makes sense that if we wish to avoid this disease then we need to return to a lifestyle and diet which is closer to our ancestors.
Symptoms of coronary heart disease
The symptoms of CHD may only begin to manifest themselves after many years or decades of physical neglect. this is why it is known as the silent killer. Most heart disease will remain hidden until it becomes a serious problem. the following symptoms indicate a well established heart problem which requires urgent medical action to prevent a major catastrophe in the sufferer’s life :-
- Chest pain, also called angina
- Shortness of breath when exercising or during another vigorous activity
A fast heartbeat - Weakness, dizziness, and feeling sick to your stomach (nausea)
- Increased sweating.
Importance of understanding the risk factors
In order to prevent CHD, we need to fully understand the causes, which involves looking at all the risk factors. There are many different reasons which cumulatively increase the risk of developing a heart condition. The major ones which are listed below are responsible for 90 percent of all first heart attacks :-
- smoking
- high blood pressure
- poor diet
- excess body fat
- insufficient exercise
- excess stress
It is never too late to reduce the chance of developing heart disease
Even after many years of neglecting our heart health, the health of the arteries can be improved by making some simple but major lifestyle changes. The most important of these are to adopt a healthy diet, take healthy exercise, lose excess weight, and quit smoking.
Gum Disease May Cause Heart Disease
A 2005 study published in the medical journal ‘Circulation’ indicates that the risk of developing stroke and heart attacks can be increased by poor dental health, and recommends that we take more care of our teeth, gums and oral health. The research showed that there is a proven link between gum disease and subsequent narrowing of the arteries, known as atherosclerosis. This is a condition for which there is no cure, and is a root cause of cardiovascular disease.
What is gum disease?
Gum disease is caused by plaque. After eating food our teeth become coated with a layer of plaque which is made up of particles of food, bacteria, and the waste by-products of the bacteria. If plaque is left on the teeth, it can cause the gums to become irritated. This irritation causes bleeding, which many of us have noticed after brushing our teeth at some time in our lives. This is the initial stage of gum disease, and is known as gingivitis. When gum disease is left untreated, the gums tend to become swollen, and more plaque accumulates around the teeth, which cannot then be removed by normal brushing with a toothbrush. Eventually this plaque hardens and forms tartar. As the tartar builds up, it can become infected, and cause periodontitis. This can cause an infection of the jaw bone, and ultimately lead to the loss of one or more teeth.
What are the symptoms of gum disease?
Normal healthy gums are pink coloured. Diseased gums usually appear swollen and red. However, occasionally the only sign of gum disease is when the gums bleed following brushing of the teeth.
Why can gum disease cause heart disease?
The following factors may contribute either separately, or in combination to the risk of heart disease in an individual with gum disease :-
The bacteria that cause gum disease may increase the rate at which arteries become blocked
Bacteria from infected gums can enter the bloodstream, and activating the immune system (the body’s defence mechanism) and making their artery walls inflamed and narrowed
Oral bacteria can enter the bloodstream and attach to the existing fatty deposits within the arteries, causing further narrowing
A protein, called C-reactive protein, is found in higher levels when there is inflammation of the blood vessels and is an indicator that atherosclerosis may develop in the future
The study involved 657 people who had shown no previous history of cardiovascular disease. In order to prove whether gum disease is responsible for an increased risk of developing atherosclerosis, the study team tested all the volunteers for 11 different types of bacteria that cause gum disease. Then they examined the arterial and other heart health factors, and discovered that the people who had the ‘gum disease causing bacteria’ also showed signs of thickening of the artery walls, which is a symptom of atherosclerosis. They also had raised white blood cell counts, which is another risk factor for atherosclerosis. The researchers also discovered that this was not the case for people who have all the other types of oral bacteria.
The narrowing of the arteries that supply blood to the heart or brain, causes oxygen and nutrient deficiency, which affects the normal working of the artery and can cause a blockage causing a heart attack or stroke.
Conclusions from the Oral Health Study
The researchers suggested that the results of the study indicate that people who have gum disease may be at a greater risk of developing atherosclerosis and heart disease.
How to prevent gum disease
The most effective way of preventing gum disease is to maintain good oral hygiene. You should brush your teeth twice a day with a fluoride toothpaste, and use a good quality toothbrush which can reach all areas of the mouth. Also you should visit your dentist regularly. This is because even thorough brushing and flossing cannot remove every trace of plaque, so your dentist needs to check your teeth regularly and remove any build up of tartar.
Treatment for Gum Disease
The main treatment for gum disease involves removing plaque and preventing it’s recurrence. Regular brushing and flossing may cure mild cases of gum disease. However when a layer of tartar has formed, this can only be removed with a special descaling tool, which requires a visit to a dentist or hygienist. Also polishing your teeth’s surfaces makes it harder for bacteria and plaque to reform. Your dentist may also recommend an antiseptic mouthwash to control plaque levels. In more serious cases , where the infection has developed into periodontitis, it may be necessary for the dentist to remove the infected tissue around the root of the tooth (also known as root planing).