Uncovering the complex relationship between PAD and diabetes

Peripheral artery disease (PAD) is a condition where plaque builds up in the arteries. This buildup causes arteries to narrow and block the flow of blood to different organs. Diabetes is a chronic disease that affects how the body produces glucose, leading to high blood sugar levels. Both conditions can lead to serious health risks if left untreated.

"Patients with PAD are at extremely high risk of having major cardiovascular adverse events such as heart attacks and strokes as well as death from heart attack and stroke, loss of limb and other complications," says Manju Jayanna, MD, MS, an interventional cardiologist with Bryn Mawr Hospital.

"In fact, patients with PAD are at some of the highest risk of major cardiovascular adverse effects and complications compared to any other groups of patients. Diagnosing PAD allows your cardiologist to aggressively treat risk factors that reduce the risk of developing such complications. We have made significant advances recently in treatment of these extremely high-risk patients."

Every day, millions of people are affected by the complex relationship between PAD and diabetes. But what's their connection?

The link between PAD and diabetes

PAD is caused by a buildup of plaque in the arteries, which is usually due to genetics, unhealthy lifestyle habits including smoking, lack of exercise and poor dietary choices.

"This condition affects the blood vessels that travel to the extremities, such as the legs and feet. If left untreated, it can cause complications including pain and sores," says Manju Jayanna, MD, MS, a interventional cardiologist with Bryn Mawr Hospital.

People with diabetes have an increased chance of developing PAD. When arteries narrow due to plaque build up, they reduce circulation in the lower extremities, making them more vulnerable to injury or infection. These areas are difficult to treat when they become infected, which can increase a person's risk of developing diabetes-related complications like heart attack and stroke.

Risk and symptoms factors of PAD

People with diabetes are at a higher risk of developing atherosclerosis, the most common cause of PAD. While PAD is related to other conditions such as coronary artery disease, it affects the arteries in the legs, rather than those leading to and from the heart.

There are several risk factors associated with PAD, including:

• Age (being over 50)
• Gender (Men are more at risk than women)
• Smoking status
• High cholesterol levels
• Diabetes mellitus (DM)
• Hypertension (HTN)
• Obesity
• Physical inactivity

The symptoms of PAD can vary depending on its severity but may include:

• Leg pain or cramps when walking or exercising that disappears after resting
• Numbness or tingling sensations in lower extremities
• Cold feet or toes
• Discoloration of skin on toes and feet
• Slow healing sores on toes/feet/legs/ankles
• Hair loss on legs and feet
• Brittle nails or thickening of toe nails

"If left untreated, PAD can lead to serious complications such as gangrene (tissue death) which could require amputation," says Dr. Jayanna.

Diagnosing peripheral artery disease

It's important to consider someone's medical history, family history, risk factors and lifestyle factors when diagnosing PAD. A physical exam can also identify signs of PAD, including poor blood pressure in the legs or feet compared to the arms.

Other tests used to diagnose PAD include doppler ultrasound and angiography, which can measure blood flow and identify areas of blockage. Doppler ultrasound uses sound waves to generate images of the arteries and detect any narrowing or complete blockages. Angiography is an X-ray imaging test that helps doctors see how well blood flows through veins and arteries.

The Ankle-brachial index (ABI) test is a simple, non-invasive test used to diagnose PAD. During this test, your doctor will compare the systolic blood pressure reading in your ankle with the systolic blood pressure reading in your arm. Both readings are taken at rest and during exercise. Low ABI values can indicate PAD or other vascular issues such as arteriosclerosis.

"In some cases, doctors may recommend additional tests such as arterial duplex, magnetic resonance angiography (MRA), computed tomography angiography (CTA) or a peripheral angiogram" says Dr. Jayanna.

MRA uses magnetic fields and radio waves to create detailed images of blood vessels. CTA combines X-rays with computer technology to create cross-sectional images of organs, like the heart or brain, that can help detect blockages or aneurysms.

It's important for people with diabetes who are diagnosed with peripheral artery disease to seek treatment from their doctor right away.

Treating PAD to reduce diabetes-related complications

Fortunately, there are steps you can take towards reducing your risk of developing PAD. Lifestyle changes are a key part of managing PAD. Diet and exercise both play important roles in reducing the risk of these types of complications.

"You should reduce your sodium intake, eat a balanced diet high in fruits and vegetables, get regular physical activity and quit smoking. If you need help to quit smoking, a smoking cessation program can help," says Dr. Jayanna.

Medications that help lower cholesterol levels or manage hypertension are important to reduce the risk of developing PAD. Patients with symptoms from PAD may find relief with angioplasty, stent placement, atherectomy and other treatment options that can help improve blood flow to the legs by opening blocked arteries. These treatments can also help your overall health by improving circulation in your legs, which can increase your energy levels and reduce leg pain.

"Regular monitoring and follow-up visits are key for making sure PAD is properly treated and managed. These patients need a multimodality approach-including medications, monitored exercise, lifestyle modifications and interventions to reduce their risk of complications," says Dr. Jayanna.

With proper lifestyle changes and medical treatments, PAD can be managed effectively so those with diabetes can lower their risk for diabetes-related complications like heart attack and stroke.

Next steps:

Make an appointment with Manju Jayanna, MD, MS
Learn more about heart and vascular care at Main Line Health
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