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Peripheral Artery Disease Up Sharply Among U.S. Women
Date:11/4/2007

The condition, which is symptomless, can lead to heart attack and stroke

SUNDAY, Nov. 4 (HealthDay News) -- More American women are suffering from asymptomatic peripheral artery disease, a circulatory condition that can signal a higher risk for heart attack and stroke, a new study found.

The increase is likely the result of an increase in common cardiovascular risk factors, namely obesity and type 2 diabetes.

But there's a silver lining -- asymptomatic (symptomless) peripheral artery disease (or PAD) can serve as an early warning system for other circulatory problems, experts say.

"The good thing about PAD is it's a peripheral marker for what's probably going on in the coronary arteries as well," said Dr. John P. Erwin III, an associate professor of internal medicine at Texas A&M Health Science Center College of Medicine.

"Treatment, especially for asymptomatic patients, is exactly what we would want people to do for coronary disease," added Erwin, who's also a cardiologist with Scott & White Hospital in Temple, Texas. "If we take tight control of diabetes, we help them lose weight, quit smoking, get cholesterol levels down. This has been very, very efficacious in preventing further stenosis [narrowing of the blood vessels] and, in some small trials, there's even been a question about regression of the disease."

The findings were to be presented Sunday at the American Heart Association annual meeting in Orlando, Fla.

Peripheral artery disease occurs when fatty deposits cause the arteries to narrow, reducing the flow of blood to the limbs -- the peripheries of the body.

The study authors, led by Dr. Andrew Sumner of the Heart Station and Cardiac Prevention at Lehigh Valley Hospital in Allentown, Pa., analyzed data from three National Health and Nutrition Examination Surveys (NHANES) between 1999 and 2004. In all, the study involved 5,376 participants aged 40 and over with no prior history of cardiovascular disease.

All participants underwent an ankle-brachial index, which measures the ratio of the blood pressure in the arms and legs.

"The very nice thing about PAD is that we have a very simple, noninvasive test that we can do that is very effective at screening," Erwin explained.

People with an index of less than 0.9 are classified as having PAD.

The study authors found that the prevalence of PAD among adults 40 years and older with no symptoms increased from 3.7 percent in the 1999-2000 survey to 4.2 percent in the 2001-02 survey, and to 4.6 percent in the 2003-04 survey.

The prevalence of PAD was highest among those aged 70 and over, but there were also increases in other age groups.

Not coincidentally, the prevalence of obesity, type 2 diabetes and hypertension increased over the time span of these three surveys, the researchers said.

Since the study findings were initially submitted, the authors did additional analysis and found startling results: PAD prevalence in women increased significantly over those six years (from 4.1 percent to 6.3 percent) but decreased in men (from 3.3 percent to 2.8 percent). Over the same period, women also exhibited an increase in the prevalence of obesity; men also experienced an increase but much less of one.

"Asymptomatic PAD is common, and we need to have a high index of suspicion in women and need to look at the risk factors that contribute to it, notably obesity," Sumner said. "We need to assess the protocols and guidelines that currently exist for which the asymptomatic person should be screened. We know that the risk of dying of heart disease with PAD is significantly higher than when individuals don't have PAD, and we need to make sure our existing guidelines reflect the increasing prevalence of this problem and accurately identify this increasing number of high-risk individuals."

Dr. Suzanne Steinbaum, director of Women and Heart Disease at Lenox Hill Hospital in New York City, added: "Here we have an increase in obesity and high cholesterol and high blood pressure, and all these risk factors are associated with an increase in vascular disease. What we really need to understand is, there are a lot of people out there with asymptomatic disease, and we need to screen them as well as for cardiovascular disease. It's the ankle-brachial index. It's a very simple test."

More information

The American Heart Association has more on peripheral artery disease.



SOURCES: Andrew Sumner, M.D., medical director, the Heart Station and Cardiac Prevention at Lehigh Valley Hospital and Health Network, Allentown, Pa.; Suzanne Steinbaum, M.D., director, Women and Heart Disease, Lenox Hill Hospital, New York City; John P. Erwin III, M.D., associate professor of internal medicine, Texas A&M Health Science Center College of Medicine, and cardiologist, Scott & White Hospital, Temple, Texas; Nov. 4, 2007, presentation, American Heart Association scientific sessions, Orlando, Fla.


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