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5 things we now know about peripheral artery disease

The common circulatory condition is a leading cause of amputations in the U.S. Learn why Black Americans are disproportionately affected and how Johnson & Johnson is helping to raise awareness about the disease.

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Up to 12 million. That’s the number of Americans who are affected by peripheral artery disease (PAD), a condition in which narrowed arteries—caused by the buildup of a sticky substance called plaque—reduce blood flow to the limbs. And yet research suggests most of these people don’t know they have the condition.

“There’s a significant lack of awareness,” says Richard Browne, M.D., Senior Medical Executive, Cardiovascular and Metabolism Medical Affairs, Johnson & Johnson. “Many people don’t know what PAD is, nor do they realize that it increases the risk of limb amputation, as well as the risk of heart attack and stroke.”

While anyone can get PAD, the disease is more common in Black Americans. That’s why the Janssen Pharmaceutical Companies of Johnson & Johnson (now known as Johnson & Johnson Innovative Medicine) has launched a new multiyear initiative called Save Legs. Change Lives.TM focused on Black Americans. It is designed to create urgency and action around the hidden threat of PAD-related amputation. “We want to shine a light on this disparity, as well as empower people to learn more about PAD and get screened for it,” says Dr. Browne.

For Minority Health Awareness Month, keep reading to learn more about this potentially devastating—but ultimately manageable, if caught early—condition.

1.

Black people have the highest risk of PAD.

A man sitting on an exam table while an HCP holds his ankle

Black Americans are twice as likely to have PAD and up to four times more likely to undergo a PAD-related amputation, compared to other Americans. “Black Americans are more likely to have traditional risk factors for developing PAD such as high blood pressure, tobacco abuse and type 2 diabetes,” says Dr. Browne. “In addition, there are disparities of medical care that put Black people at increased risk of bad outcomes with PAD.”

These risk factors may be why Black people are at higher risk of developing complications, he adds. “My own father-in-law had both legs and his right arm amputated in his 50s, which is why PAD is such a passion for me,” says Dr. Browne. “He died before his 60th birthday and never got to meet his grandson.”

Black people also face significant issues with access to healthcare, he adds. “We know that Black patients are more likely to have their symptoms ignored, which means they’re more likely to go undiagnosed,” he says. “By the time their PAD is recognized, they’ve developed more severe disease that requires amputation. Research suggests that Hispanic people are also more likely to develop the complications of PAD and have worse outcomes.”

Worse yet, over 70% of patients who have an amputation die within three years.
Through “Save Legs. Change Lives.” Johnson & Johnson is focused on helping those at increased risk of PAD through more than 12 programs across three focus areas: empowering individuals and communities placed at an increased risk of PAD, collaborating with partners and driving research. This past year, a mobile screening unit provided more than 3,200 free PAD screenings across the United States.

2.

PAD can be symptomless.

The classic PAD symptom is pain in the leg that occurs when you walk or climb stairs and then gets better with rest. But up to 50% of people with PAD don’t experience any symptoms at all, according to the National Institutes of Health.

“Peripheral artery disease is so insidious because even asymptomatic patients are at risk of complications from PAD, such as sores, infection and even amputation,” says Lyssa Ochoa, M.D., vascular surgeon and CEO of the San Antonio Vascular and Endovascular Clinic.

Other symptoms of PAD include a cold foot or toes, change in skin coloration, leg weakness or numbness that makes it hard to walk, skin that appears shiny due to the loss of leg hair and sores or wounds on the soles of your feet that refuse to heal.

If you notice any of these symptoms, let your doctor know right away.

3.

PAD is easy to diagnose.

A close-up of someone having a Doppler ultrasound on a vein in their arm

A simple, noninvasive test called the ankle-brachial index (ABI) can be performed by your doctor to check for poor circulation by comparing the blood pressure in your arms and legs. “As an example, someone with PAD may have a blood pressure of 100 in their arm, but only 60 in their leg,” explains Dr. Browne. “That would give them an ABI of 0.6 (which is 60/100). An ABI of less than 0.9 is a strong predictor of the presence of PAD.”

But this isn’t the only test your doctor can use to diagnose or screen for PAD. They will also take a careful medical history and perform a complete physical exam, which includes checking for weak leg pulses or abnormal sounds that may indicate poor blood flow. Other tests, like a Doppler ultrasound or a CTA (short for computed tomography angiography), can confirm the diagnosis and locate a precise area of blood-vessel blockage.

4.

You’re more likely to develop PAD if you have coronary artery disease—and vice versa. “The primary cause of both is atherosclerosis, or the buildup of fatty deposits in the arteries,” explains Dr. Browne. In fact, if you already have heart disease, you have a one in three chance of developing PAD. Other risk factors include:

  • Age. The older you are, the more likely you are to develop PAD.
  • Smoking. Those who smoke or have a history of smoking are up to four times more likely to develop PAD.
  • High blood pressure. Hypertension stresses the inner lining of blood vessels, leading to increased risk of plaque buildup in the walls of the artery.
  • Diabetes. Around one in three people with diabetes over the age of 50 has PAD.
  • Elevated cholesterol. Extra cholesterol and fat in your blood cause more plaque to form, which may block blood flow to your limbs.

5.

You can live a long, full life with PAD.

Two people wearing aprons and cooking a healthy meal together

There’s no cure for PAD—once you’re diagnosed with it, you have it for life—but there are treatments to help you live with the condition, notes Dr. Ochoa. They include:

Lifestyle changes
“This is the first step toward managing the condition,” notes Dr. Ochoa. Those changes include choosing a heart-healthy diet rich in fruits, vegetables, whole grains and low-fat dairy; staying active (your doctor may recommend a supervised PAD exercise program); giving up cigarettes if you smoke; and maintaining a healthy weight. If you’re overweight, losing just 5% of your body weight can help lower your chances of developing certain risk factors for PAD, such as high blood pressure or high cholesterol.

Medications
“These are both to treat PAD and also to help get other conditions that can worsen PAD—like high cholesterol or blood glucose levels—under control,” says Dr. Ochoa. Your doctor may recommend antiplatelet medicines such as aspirin to prevent blood clots and further narrowing of the arteries, cholesterol-lowering drugs like statins or blood pressure medications such as angiotensin converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) to prevent blood vessels from narrowing.

Procedures
If the blood flow in one of your limbs is blocked, you may require a procedure to open up those blocked blood vessels, explains Dr. Ochoa. The most common procedure is angioplasty, where a catheter is inserted to open a blocked artery with a tiny inflated balloon. If an artery is completely blocked, you may require bypass surgery, in which a vein from elsewhere in your body is used to reroute blood flow around the blocked-off artery.

Ultimately, more research on PAD is needed. That’s why Johnson & Johnson has created the Health Equity Assessment Tracker (HEATMap), a tool that identifies U.S. counties that experience racial health inequalities to access care.

“It shows us which parts of the country have the highest rates of racial disparity in regard to amputation and allows us to look at healthcare systems that do a better job,” says Dr. Browne. Johnson & Johnson has also partnered with groups such as the Association of Black Cardiologists and The Balm in Gilead, Inc., a faith-based organization engaged in eliminating health disparities.

“Ultimately, our goal is to create more inclusive care for everyone affected by PAD,” adds Dr. Browne.

*This story was updated on February 14, 2024.

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