More Information on Peripheral Arterial Disease

PERIPHERAL ARTERIAL DISEASE

(Hardening of the Arteries)

 

Most Peripheral Arterial Disease (PAD) is caused by atherosclerosis: the accumulation of fatty deposits (plaque) in the artery wall which narrows the space where the blood flows.

 

There is currently no cure for atherosclerosis. However, there are ways to improve your symptoms and prevent disease progression. Having PAD, caused by atherosclerosis, also increases your risk of heart attack and stroke, so…….

 

THINK ABOUT SOME LIFESTYLE CHANGES!

STOP SMOKING

Stopping smoking is the most important thing you can do to prevent your arterial disease getting worse. Indeed, other lifestyle changes are likely to be less effective if you do not stop smoking as well. Each time you smoke a cigarette it squeezes up your arteries, making them even narrower. This further reduces the amount of blood flowing down your legs and raises your blood pressure. Smoking also prevents your blood carrying as much oxygen as it should, and makes it more likely to clot and block an artery or a bypass graft.

 

It is easy to say ‘just stop smoking!’, but stopping need not be as difficult as you imagine. Nicotine replacement therapy (available as ‘patches’, lozenges or chewing gum) or Zyban tablets (Bupropion) from your doctor will make the task much easier. Advice about which is most appropriate for you, and ongoing support from smoking cessation specialists is available for all – ask your nurse for details.

 

INCREASE YOUR REGULAR EXERCISE

 

Physical activity promotes the growth of smaller blood vessels to bypass the narrowing or blockage in your artery. If you have already had a stent inserted in the artery, or a bypass graft operation, it will help to maintain good blood flow through it.

 

A purposeful daily walk is the most important exercise. Walk as far as you can without stopping, at a comfortable pace. Try to get a little farther each day, before you have to stop, even if it’s only a few steps more!

 

The vascular nurse specialists will show you simple exercises which you should try to do every day at home, gradually increasing your activity. If you have no heart or breathing problems, you may be able to join a physiotherapist-led exercise group for people with PAD, but this does involve regular weekly attendance.

 

HEALTHY EATING

 

The food you eat may increase your risk of arterial disease – simple changes to your diet will help to reduce your risk. Eat less fat, especially animal (saturated) fat. This is found in high quantities in red meat, butter, cheese, full fat milk and cream.

 

  • Eat more fruit and vegetables, aiming for five portions each day. These provide antioxidants which slow up the progress of atherosclerosis.
  • Reduce sugar and sugary foods. High sugar intake increases your risk of developing diabetes.
  • Eat more ‘Omega 3’ fats as these have been shown to reduce the risks of atherosclerosis. The best source is oily fish, such as sardines, pilchards, mackerel, salmon, tuna, trout, herring, kippers. Eat more fibre and starchy foods, such as porridge, bran cereals, baked beans, wholemeal pasta and bread.
  • Aim to lose weight if you are overweight. This will prevent your legs having to work harder carrying the extra weight around and will enable you to be more active. Reduce your salt intake and keep alcohol to a minimum—both salt and alcohol will raise your blood pressure if taken in high quantity.
  • Your doctor may prescribe tablets called ‘statins’ to help reduce your cholesterol. In rare cases, a tendency to high blood cholesterol may be inherited.

 

DIABETES

 

Having diabetes means the body is unable to control the amount of sugar circulating in your blood as it usually would. Fluctuating blood sugar levels speed up the progress of arterial disease, and it is known that PAD in diabetics tends to affect smaller arteries (the ‘microcirculation’), making it more difficult to treat. It is very important that you take your insulin or diabetic tablets regularly as prescribed. Keep to a healthy diet with minimum sugar content. Monitor your blood sugar regularly as advised by your diabetes nurse – in most cases aiming for

 

4 - 7 mmols/litre

 

and be sure to have a regular yearly blood test – called HbA1C – to check whether your diabetes has been well controlled over a longer period.

 

BLOOD PRESSURE

It is known that high blood pressure (or hypertension) will increase progress of arterial disease, therefore also raising the risk of heart attack and stroke.

 

You should have your blood pressure checked regularly (a minimum of six monthly) by your practice nurse. Usually, if you have PAD, we would like your blood pressure to be around

140/80 or 135/80 if you are diabetic.

If your blood pressure is found to be high, tablets will be prescribed to reduce it. You can also help by reducing the salt in your diet, the amount of alcohol you drink and your body weight if needed.

 

FOOT CARE

 

Make a point of looking carefully at your feet every day after washing them, using a mirror to see the soles if necessary. Because the blood supply to your feet and lower legs is reduced, any skin damage will not heal as well as you might expect.

 

Note any developing redness, blisters, cuts, abrasions and soreness, which might herald the start of an ulcer. Observe to ensure this heals satisfactorily - if it deteriorates, see your GP. If your skin is dry, use a simple moisturising cream to keep it supple and healthy.

 

Foot care is particularly important if you have diabetes, as the small nerves in the legs and feet can also be affected, causing ‘neuropathy’, or altered sensation. This makes it possible for you to damage the skin on your feet without realising it. Never walk barefoot and make sure you have well-fitting shoes.

 

MEDICATION

 

Be sure to take any medication exactly as your doctor has prescribed.

 

Your doctor will probably advise that you take a small daily dose of Aspirin (75mg). This is to ‘thin’ the blood, so it is less likely to form a clot which may block a narrowed artery or a bypass graft. If there is a reason why you should not take Aspirin, other tablets (Dipyridamole or Clopidogrel) may be prescribed instead.

 

You will also be prescribed a ‘statin’ tablet, which will lower your cholesterol if necessary and reduce your risk of heart attack and stroke.

 

If you have high blood pressure (hypertension), your doctor will prescribe tablets to reduce it.