Black Americans Have the Highest Risk of Peripheral Artery Disease—But Most Have Never Heard of It
Fact checked by Nick Blackmer
A new survey found 70% of participants were not familiar with peripheral artery disease (PAD), a common cardiovascular disease that can lead to stroke, amputation, or death.
PAD is especially prevalent in Black and Hispanic American populations, and among people who have diabetes, high blood pressure, and those who smoke.
The results emphasize that patients and healthcare providers should work together to boost PAD awareness, experts said.
Most Americans are unaware of peripheral artery disease (PAD), a new survey finds.
PAD is a cardiovascular disease that causes blockage in the vessels that carry blood from the heart to the legs, making it hard for blood to flow freely in your legs. It is a serious medical condition that can lead to stroke, heart attacks, leg amputations, and in some cases, death.
The PAD Pulse Consumer Survey polled 2,000 Americans to learn about their level of awareness of disease symptoms, risk factors, and overall doctor-patient communications around PAD.
PAD is a common cardiovascular disease, that affects more than 12 million Americans. Despite the disease’s clinical prevalence, nearly 70% of survey respondents reported that they were not familiar with PAD.
“Honestly, while I was certain that the general public awareness of PAD was low, I did not anticipate that it was at such a dismal rate.” Kumar Madassery, MD, director of the Peripheral Vascular Intervention & CLI Program at the Rush University Medical Center, told Health. “This survey helps us demonstrate a critical need to find collaborative means to improve this for the sake of the general population, our patients, and the viability of healthcare as a system.”
PAD is commonly caused by atherosclerosis, which is the buildup of fat and cholesterol in your arteries. Because of this, muscles in your legs don’t get enough blood and oxygen even while resting. PAD mostly affects men over the age of 50. The three main risk factors for developing PAD are high blood pressure, smoking or tobacco use, and diabetes.
“It is surprising to me that nobody knows about PAD, one of most of the critical complications of diabetes,” said Anahita Dua, MD, MBA, a vascular surgeon and co-director of the Peripheral Artery Disease Center and Limb Evaluation and Preservation Program at Massachusetts General Hospital.
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While Black and Hispanic Americans Are Most at Risk, Disease Awareness Lags Behind
The survey included responses from 500 Black Americans and 500 Hispanic Americans, which is important given that these populations are at a higher risk of developing PAD and experiencing PAD-related complications in their lifetime.
Black Americans are twice as likely to develop PAD compared to White Americans. Approximately 30% of Black men and 27% of Black women will develop PAD in their lifetimes. For Hispanic Americans, cases of PAD are usually aggressive, with the risk of major amputation and death within one year of diagnosis as high as 17%.
Over 70% of both Black and Hispanic survey respondents reported currently having one or more risk factors or knowing someone who had one or more risk factors for PAD. However, Black and Hispanic participants consistently responded that they felt they were at little to no risk of developing PAD.
“Nearly 80% of Black and Hispanic adults have never had a doctor or healthcare provider talk with them about PAD. Our survey determined that many of these discussions are not happening,” Foluso Fakorede, MD, an interventional cardiologist at Cardiovascular Solutions of Central Mississippi, told Health.
High rates of PAD are not limited to Black and Hispanic minority communities. “PAD also disproportionately affects Native Americans and South Asians,” Dua told Health. “Minority patients experience higher rates of PAD and amputation. We need to be able to get the message out to these communities that they need to be checked regularly for PAD.”
This speaks to a larger issue of healthcare outreach in minority communities.
Related: What Are Social Determinants of Health (SDOH)?
Symptoms and the Challenges of Early Diagnosis
The early symptoms of PAD include feelings of pain, achiness, cramping, and discomfort in your feet, calves, or thighs. These symptoms happen while walking or doing exercise and can go away after resting.
One of the challenges of diagnosing PAD is that most people consider regular leg pain as a normal part of getting older. In the PAD survey, 91% of respondents said that leg aches and pains are common as people age; 53% also said they would go more than a week with persistent leg pain while walking before talking to a healthcare provider about it.
These survey findings reveal that patients are likely to dismiss initial symptoms, making early diagnosis challenging.
Another aspect of PAD that makes early diagnosis hard is that many people with PAD may not present explicit symptoms right away. Because of this, experts recommend reaching out to your healthcare provider immediately for a PAD screening if you have any of the three PAD risk factors (diabetes, high blood pressure, or are a smoker).
“If a patient is experiencing potential PAD symptoms or has any risk factors, it is important to talk with a doctor right away, whether it be a primary care provider, ER, or community clinic,” said Fakorede.
Reaching out to a healthcare provider can quickly help you get a diagnosis. Healthcare providers test for PAD using an ankle-brachial index (ABI) test. This test is “a simple, low cost and non-invasive test that can help determine if a patient has PAD. This is simply a test comparing blood pressure at the arm and the ankle,” said Madassery.
As the disease worsens, symptoms become more severe. Symptoms of advanced PAD include:
Loss of hair in the lower legs
Very thickened toenails
Feet that are cool to the touch
Skin becoming pale or blue
Sores and injuries in the feet that won’t heal
Gangrene (dead body tissue due to lack of blood supply)
If left untreated, severe cases of PAD can result in a leg amputation and, along with it, high mortality rates. According to Dua, 50% of patients who have to undergo a leg amputation due to complications of PAD pass away within the first two years after amputation.
Additionally, Dua explained that amputations can severely impact patients’ mental health, citing numerous studies about the increased rates of depression in patients who have had an amputation. “The physical and mental toll this takes on patients and family members is immense,” added Madassery.
Related: Causes and Risk Factors of Heart Disease
Treating PAD
Treatment includes addressing the underlying conditions that increase your risk of developing PAD. If you are a smoker and are diagnosed with PAD, quitting smoking can reduce the risk of your disease progressing. Additionally, managing blood pressure and diabetes is key for people with PAD to improve their condition. Some of the ways PAD is treated include:
Managing your blood pressure and blood sugar with the help of medications as prescribed by your doctor
Developing a structured exercise regimen alongside your healthcare provider to improve circulation in your legs
Avoiding cuts and scrapes on your feet
Taking medications to avoid blood clots
Taking medications that help widen your arteries
Taking medications that can help lower your cholesterol
It is important to note that any medications prescribed to manage your blood pressure and diabetes should be taken as indicated by your healthcare provider.
In some severe cases, surgery might be required. These surgical procedures can include opening a blocked blood vessel or rerouting the blood supply around a blocked artery to provide blood flow to the legs.
Related: 13 Effective Ways to Lower Your Blood Pressure
A Need to Improve Awareness
The PAD survey findings highlight the large gap in public awareness of PAD as a leading cardiovascular disease. This lack of awareness is more pronounced when it comes to Black and Hispanic communities, which are at a higher risk.
There is a need for patients, physicians, insurance providers, and government entities to work together to improve PAD awareness and patient outreach.
“I think all of us in healthcare have done a poor job of educating patients, providers, and governing bodies as to the importance of primary PAD prevention, detection, and early conservative management,” said Madassery. “I strongly believe with everyone involved in healthcare working together for the common goal of reducing this preventable disease burden, we can achieve a significant benefit to not only patients themselves but also to the entire healthcare system.”
“Medical care in this country has advanced in multiple areas over the last 50 years, but we have not with it advanced our education and engagement with our patients so that they know what to be looking for,” said Dua.
The PAD Pulse Consumer Survey hopes to be a step in the right direction to improve PAD awareness in the public eye and improve patient outcomes.
“It’s important for patients to be engaged with this information so they can help us take care of their health,” said Dua, “and we can make sure they live the happiest and healthiest lives they can.”
Related: Most People Don't Know What a Normal or Healthy Blood Pressure Is, Study Shows
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