How peripheral artery disease may cause lower limb amputation if left unchecked
The little-known peripheral artery disease (PAD) is the third most common clinical manifestation of atherosclerosis, after coronary artery disease (CAD) and stroke; and is also associated with a significantly increased risk of cardiovascular morbidity and mortality. Professor Tan Huay Cheem, Director of Singapore’s National University Heart Centre (NUHCS) explains that PAD is characterised by debilitating atherosclerotic obstruction of peripheral arteries (those channelling blood away from the heart), affecting the lower limbs or the arms, neck and abdomen. These typically present with the occasional limb/leg cramping (claudication), pain, weakness, or numbness because of reduced or sudden lack of blood flow to a limb, thus making physical activity difficult – severe instances can even cost a limb.
While diabetes is the probable culprit for PAD’s increasing global complaints, especially across Asia, a variety of factors may contribute: Japan and Singapore, for example, due to their socioeconomic status and well-developed healthcare systems, are better equipped to handle cases like PAD. However, low- and middle-income countries (LMICs) such as Indonesia or the Philippines, with their prevalence of smoking and obesity, are less likely to fare as well. Besides these, individual risk factors include high blood pressure, high cholesterol, family history of heart disease, and excess levels of C-reactive protein (CRP) or homocysteine which suggests heart disease.
People with PAD report mild/no symptoms in the early stages, but Professor Tan explains that PAD can and does affect both sexes, with men prone to developing it in their 50s or 60s and women a decade or so later, when the disease is more severe. In addition, a cold feeling in the affected limb, sores that don’t heal properly/completely, patches of shiny skin or slow hair/toenail growth on the same limb may also be indicative of PAD.
Despite their distressing symptoms, the treatment and management of PAD,which is primarily aimed at preventing a heart attack or stroke, will entail simpler and more doable lifestyle changes and regular exercise to improve the patient’s general cardiovascular health. An individual regimen will also be tailored to manage any comorbidities and prescription medication the patient may have/need. Meanwhile, as people in the Eastern Mediterranean, home of the “Mediterranean diet” were shown to have the lowest incidence of PAD, switching to a more plant-based diet is recommended for good cardiovascular health.
Finally, for advanced PAD that is limiting mobility and causing severe pain, surgical intervention may be needed to widen a clogged artery or bypass it entirely. To date, a balloon angioplasty – to prop a blocked artery open – is the most common procedure.
As mentioned earlier, PAD often presents no symptoms but one should be proactive about its telling signs and consult a doctor. Professor Tan advocates screening for those over 40 years old and suffer from diabetes and other peripheral artery disease risk factors, as having more risk factors amplifies your personal risk of PAD.
