Peripheral Artery Disease 101

03/02/2020 | 6 min. read

Dr. Stephen Sinatra

Dr. Stephen Sinatra

Do you experience pain or cramping in your legs while walking or climbing stairs? How about feet that are cold to the touch, slow-healing sores, or hair loss on your lower legs?

These symptoms could be due to a number of conditions, but if you’re in your 60s or older—especially if you have diabetes, high blood pressure, or a history of smoking—you may have peripheral artery disease.

Peripheral artery disease affects 10–20% of Americans in their 70s and 80s, as well as a growing number of younger people. But because nearly half of those affected have no overt symptoms, it is often overlooked.

This is unfortunate. Peripheral artery disease is a serious cardiovascular disorder associated with life-changing functional impairments and life-threatening complications. Let’s look at what you can do to prevent and treat it.

What Causes Peripheral Artery Disease?

Like many other cardiovascular diseases, peripheral artery disease is caused by atherosclerosis: the buildup of plaque in the arterial walls that narrows the arteries and limits blood flow.

It’s similar to the plaque buildup responsible for heart disease and heart attacks. In fact, a primary difference between coronary artery disease and peripheral artery disease is location. The former affects the arteries that supply the heart while the latter affects the peripheral arteries that deliver blood to the outer regions of the body—including the lower extremities, the area most commonly affected.

What Does It Feel Like?

Just as narrowed coronary arteries restrict blood flow and can cause chest pain (angina), narrowed arteries in the lower extremities can cause leg pain and cramping. And just as angina is usually triggered by exercise, the leg pain generally comes on only with activity and resolves after a short rest. This is called intermittent claudication (from the Latin word for lame or limp), and it is essentially angina of the legs.

Yet, although intermittent claudication is considered to be the classic telltale symptom, fewer than half of affected patients experience it. Therefore, you need to be aware of the more subtle signs and symptoms of peripheral artery disease such as hair loss on the legs and feet, sores that are slow to heal, slow-growing toenails, noticeably cold feet, and legs that are pale or shiny in appearance.

More Than a Pain in the Leg

It’s important to stay on top of early signs and symptoms because peripheral artery disease is a progressive disorder that can lead to impaired mobility, restriction of daily activities, and loss of independence. Plus, in advanced cases it can lead to gangrene, amputation, and even premature death. 

Peripheral artery disease may also be a warning sign of other cardiovascular problems since atherosclerosis is a systemic disease that affects arteries throughout the body. Therefore, if you have peripheral artery disease, you have a higher risk of heart attack, stroke, and heart failure. Likewise, hypertension, heart disease, etc., increase your odds of having or developing peripheral artery disease.

Discuss this with your doctor, who may recommend screening. The most common test for determining peripheral artery disease is the ankle-brachial index (ABI), a simple, noninvasive procedure that compares the blood pressures in your ankles and arms at rest and right after exercise. A low ankle-brachial index is suggestive of arterial narrowing in your legs.

Prevention = Eliminating Risk Factors

The advice I give my patients for preventing peripheral artery disease is the same advice I give for preventing coronary artery disease, hypertension, and other cardiovascular disorders. Eat a heart-healthy diet. Exercise regularly. Maintain your ideal weight. Manage your stress level. And pay special attention to these two risk factors:

  • Smoking: Smoking is so closely related to peripheral artery disease that it is sometimes referred to a smoker’s disease. A recent analysis from the American College of Cardiology reported that 80% of affected individuals were current or former smokers! I know quitting isn’t easy but do whatever it takes to stop smoking.
  • Diabetes: Elevated blood sugar damages the arteries and contributes to atherosclerosis. An estimated 20–30% of patients with peripheral artery disease also have diabetes—and having both conditions is a double whammy that worsens outcomes and increases the risk of amputation.

How Do You Treat Peripheral Artery Disease?

Exercise may be the last thing on your mind if walking for just a few minutes causes leg pain. Yet, exercise is a key component of any treatment plan. Dozens of studies over the past 30 years have shown that people who participated in supervised exercise programs had significant improvements in how far they could walk before leg pain set in, peak walking distance, and overall function and quality of life.

Commonly prescribed medications for peripheral artery disease include statins, blood pressure-lowering drugs, antiplatelets (to help prevent blood clots), and pain meds. In cases of severe peripheral artery disease, surgery such as angioplasty to open narrowed arteries and vascular surgery to bypass blockages may be indicated.

Unfortunately, many patients remain symptomatic after surgery. This was recently demonstrated in a five-year study by Swedish researchers. Although patients who had undergone angioplasty reported immediate benefits, they did no better over the long term than study participants who had followed a noninvasive course of exercise and medications.

I am not surprised. Atherosclerosis affects small blood vessels as well as the large arteries that are the target of surgery. So what if you prop open or bypass one or two vessels? You still have small vessel disease—and unless you do something to curtail it, disease progression is inevitable.

Integrative Approach to Peripheral Artery Disease

That’s why, no matter what treatment course you select, I also recommend a comprehensive nutritional program that supports your body’s natural defenses and repair mechanisms.

Impaired blood flow deprives your cells of oxygen and nutrients, which sets into motion a cascade of metabolic abnormalities. Among them are a reduction in the amount of ATP (energy) produced by your body’s cells and an increase in oxidative stress and inflammation—which further damages the arteries as well as the muscle fibers and nerves.

Poor circulation also inhibits the removal of metabolic waste products, so muscle cells swell and press against adjacent blood vessels, causing additional narrowing of already narrowed arteries.

The integrative approach simply increases the availability of nutrients that serve as critical cofactors for essential metabolic processes. Boosting ATP production in the mitochondria, revitalizing antioxidant and anti-inflammatory defenses, and turning on key repair mechanisms helps slow the damage and jumpstarts the healing process.

Recommended nutrients for peripheral artery disease include:

  • Coenzyme Q10: 100-300 mg daily
  • Magnesium: 200-600 mg daily
  • L-carnitine: 1-3 grams daily (One particular form, propionyl-L-carnitine, has also been to increase maximum walking time and distance in patients with peripheral artery disease.)
  • D-ribose: 5 grams, three times daily
  • Omega-3s: 1-2 grams of fish or squid oil daily
  • Daily multivitamin: with robust doses of antioxidants and other essential vitamins and minerals

A final aspect of the integrative approach I recommend is grounding. Walking barefoot on grass, concrete, and especially on the beach with an incoming tide is another way to get precious electrons into the body to help support ATP—the energy of life.

In Summary

Many people are still in the dark about peripheral artery disease. My recommendation, particularly if you are in your 60s or older or have any of the risk factors noted above, is to discuss screening with your doctor, make the appropriate lifestyle changes, and—if it’s too late for prevention—embrace the integrative approach.

Dr. Stephen Sinatra

Meet Dr. Stephen Sinatra

Dr. Stephen Sinatra is a highly respected and sought-after cardiologist and nutritionist with more than 30 years of clinical practice, research, and study. His integrative approach to heart health focuses on reducing inflammation in the body and maximizing the heart's ability to produce and use energy.

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