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Peripheral Arterial Disease

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Interdisciplinary Concepts in Cardiovascular Health

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Abstract

Peripheral arterial disease (PAD) is characterized by an impaired blood supply to the lower extremities, and the prevalence of PAD increases with age. Patients with PAD show intermittent claudication and ischemic ulcers, depending on the degree of ischemia in the lower extremities, and in addition, are often complicated with cardiovascular disease represented by coronary artery disease. Accordingly, the rate of mortality due to cardiovascular disease and the total mortality rate are known to be higher in patients with PAD compared with individuals without PAD.

The traditional risk factors of PAD are ageing, smoking, diabetes mellitus, dyslipidemia, and hypertension. In particular, ageing, smoking, and diabetes strongly affect the onset of PAD. Race/ethnicity, an elevation of blood inflammatory markers, chronic kidney disease, and obesity (metabolic syndrome) are also known as nontraditional risk factors for PAD.

Smoking strongly influences both the onset and progression of PAD. There is a dose-response relationship between smoking and the incidence of PAD, and the prevalence of PAD was reportedly 3–4 times higher in heavy smokers than in nonsmokers. Smoking-induced vascular endothelial cell injury, dyslipidemia, and increased blood coagulability facilitate atherosclerosis and increase the vascular tone. These detrimental effects of smoking are, in part, explained by the increase in reactive oxygen species caused by smoking.

Diabetes mellitus is also a major independent risk factor for PAD, and PAD is classified as a diabetic macroangiopathy. The relative risk of diabetic vs. nondiabetic patients for PAD has been shown to be 2.0–3.0. PAD patients with diabetes are characterized by the presence of distal vascular lesions such as infra-femoral, and especially infra-popliteal and posterior tibial artery lesions. The risk of limb amputation in PAD patients with diabetes is greatly increased by the complication of “diabetic foot,” which is classified as a diabetic microangiopathy that is caused by increased vascular permeability and a decreased neurogenic vasodilatory response. In patients with diabetes, hyperglycemia and insulin resistance cause endothelial damage which leads to the formation of the initial lesion occurring before atheroma formation. The pathogenesis of PAD in patients with diabetes is explained by disorders of vascular endothelial cells, vascular smooth muscle cells and platelets caused by activation of the diacylglycerol (DAG)-protein kinase C (PKC) pathway, the overproduction of advanced glycation end products (AGE), and activation of the polyol metabolism pathway.

The ACC/AHA guidelines for the management of PAD and the TASC I and II recommended aggressive lifestyle change, including smoking cessation, and medication therapy for diabetes, hypertension, and dyslipidemia to modify the risk of PAD, which aim to prevent the onset of PAD, improve the symptoms of intermittent claudication, and avoid lower limb amputation. Furthermore, PAD is an independent risk factor for cardiovascular disease, and thus, careful risk modification against PAD is thought to decrease the morbidity and mortality of cardiovascular disease.

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Authors and Affiliations

  1. Department of Cardiovascular Surgery, Yamagata Saisei Hospital, Okimachi 79-1, Yamagata, 990-8545, Japan

    Yoko Sotoda MD, PhD

  2. Department of Environmental and Preventive Medicine, Hyogo College of Medicine, Mukogawa-cho 1-1, Nishinomiya, Hyogo, 663-8501, Japan

    Ichiro Wakabayashi MD, PhD

Authors
  1. Yoko Sotoda MD, PhD
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  2. Ichiro Wakabayashi MD, PhD
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Corresponding author

Correspondence to Ichiro Wakabayashi MD, PhD .

Editor information

Editors and Affiliations

  1. Department of Environmental and Preventi, Hyogo College of Medicine, Hyogo, Japan

    Ichiro Wakabayashi

  2. Institute of Biophysics, Medical University of Graz Center for Physiological Medicine, Graz, Austria

    Klaus Groschner

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© 2014 Springer International Publishing Switzerland

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Sotoda, Y., Wakabayashi, I. (2014). Peripheral Arterial Disease. In: Wakabayashi, I., Groschner, K. (eds) Interdisciplinary Concepts in Cardiovascular Health. Springer, Cham. https://doi.org/10.1007/978-3-319-01074-8_6

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