PAD

[Guest guest]

One-Third of Patients Older Than 50 With Diabetes Have PAD

Date: Monday, December 06 @ 17:53:05 EST

Topic: DIC Newsletter Issue 237

Patients with diabetes and PAD have already developed evidence of

atherosclerosis and are at increased risk for myocardial infarction,

stroke, or cardiovascular death, even without symptoms.

One out of every three patients with diabetes who are older than 50 is

estimated to have peripheral arterial disease (PAD), an atherosclerotic

condition that can threaten " life and limb. " PAD is a warning of future

heart disease, stroke, or death, and is a condition that can lead to

amputation of the foot or leg if not properly treated.

Patients with atherosclerosis in a limb frequently also have it in their

coronary and cerebral arteries. If PAD is identified, we know that the

patient already has a very serious vascular problem. Once someone has

PAD, the risk of developing a serious cardiovascular event, such as a

heart attack, stroke, or death, increases to five or six times that of

patients without PAD. Patients with diabetes primarily die from

cardiovascular disease.

Many people with PAD do not present with symptoms. Approximately one

third of patients with PAD have intermittent claudication-aching or

fatigue in the leg muscles while walking even short distances and slow

walking speed.

Patients with severe PAD may develop pain in the foot or toes, or even

sores and ulcers.

Especially for patients who are 50 or older and have diabetes and/or

smoke, physicians should check the lower body for the following signs of

PAD: decreased or absent pulse; bruits; cool, pale, or blue feet; and

refractory wounds or necrosis in the feet and legs.

If ulcers appear on the toes or above the bones of the feet, or the foot

becomes pale or cyanotic, the patient is at increased risk for gangrene

and amputation, and a referral to a vascular specialist may be urgent.

The ankle-brachial index (ABI) is a simple test that can assist in the

diagnosis of PAD. This noninvasive test determines the ratio of systolic

blood pressure (SBP) levels taken in the arms and the ankles. A

hand-held 5 to 10 MHz Doppler probe and a blood pressure cuff are the

only tools needed to perform the ABI. Clinicians measure resting blood

pressure levels in both arms and both ankles. The SBP measured at each

ankle is then divided by the higher of the two brachial artery SBPs to

derive the right and left ABIs. The normal range is an ABI between 0.91

and 1.30. Mild and moderate obstruction ranges from 0.40 to 0.90. Severe

obstruction is defined as an ABI lower than 0.40 to 0.90. Severe

obstruction is defined as an ABI lower than 0.40.

Patients with diabetes and PAD have already developed evidence of

atherosclerosis and are at increased risk for myocardial infarction,

stroke, or cardiovascular death even if they don't have symptoms in

their legs when they first visit their doctor.

Physicians should check for signs of PAD during the routine physical

examination every year. An ABI should be performed in all persons with

diabetes who are older than 50 and in any that have symptoms of PAD.

Patients who have PAD will need to be thoroughly educated on their

condition because they must be absolutely meticulous in their foot care

to prevent the formation of ulcers.

Established therapies are available to reduce the risk of

atherosclerosis and its complications, particularly in patients with

diabetes. These patients need aggressive treatment for their diabetes

and other risk factors, including behavior modification and antiplatelet

therapy. They should be advised to stop smoking, control hypertension,

and begin statin therapy, which is now recommended for most patients

with diabetes regardless of their cholesterol levels.

Many patients with intermittent claudication benefit from supervised

exercise rehabilitation therapy, which involves walking on a treadmill

or track for a minimum of 30 minutes at least three times a week for 12

weeks. Two drugs for patients with symptomatic PAD have been approved by

the FDA, pentoxifylline and cilostazol. Of these, the one that is most

effective for PAD is cilostazol, but this drug should not be used in

patients with congestive heart failure.

Endovascular interventions or surgical revascularization may be

considered in some patients with severe symptoms of PAD. Any patient who

has foot pain at rest or a sore, an ulcer, or gangrene developing in the

foot has an urgent condition. That patient should be referred to a

vascular specialist for evaluation and treatment.

We have not been aggressive enough in diagnosing PAD and other

atherosclerotic diseases in patients with diabetes, nor have we been

aggressive enough in instituting risk factor modification, antiplatelet

therapy, and education about foot care and treating symptoms of PAD.

cappie

Greater Boston Area

T-2 10/02 9/04 A1c: 5.3

max 100 carb diet, walking, Metformin.

ALA/EPO, Coq10, B12, ALC, Vit C

Cal/mag, low dose Biotin, full spectrum E,

Policosanol, fish oil cap,

fresh flax seed, multi vitamin,

Lovastatin 20 mg, Enalapril 10 mg

11/04:143 lbs (highest weight 309),

5' tall /age 66,

cappie@...

[Guest guest]

> One-Third of Patients Older Than 50 With Diabetes Have PAD

>

> Patients with diabetes and PAD have already developed evidence of

> atherosclerosis and are at increased risk for myocardial infarction,

> stroke, or cardiovascular death, even without symptoms.

Thank you for the warning, but nobody needs to be a victim. PAD can

be avoided and reversed with a proactive plan at home.

regards,

Duncan Crow