Item #10
Clogging
of Leg Arteries Overlooked by Primary-Care Doctors
Aggressive
treatment to lower blood pressure in diabetics with clogged leg
arteries significantly reduces the risk of heart attacks and strokes,
researchers say.
Diabetes
and high blood pressure are key risk factors for peripheral arterial
disease (PAD), a form of atherosclerosis that affects arteries leading
to the legs and feet, say the researchers from the University of
Colorado Health Sciences Center.
PAD
affects 8 million to 12 million Americans, the American Heart
Association says. Cholesterol-laden plaque builds up in the blood
vessels and reduces blood flow to the legs. That limited blood flow
can't meet the demand from legs when a person with PAD is walking or
exercising, and that shortfall results in pain, aching and fatigue in
the legs.
In
a study published in the Jan. 21 issue of Circulation, the researchers
say clogging of leg arteries, though often overlooked by primary-care
doctors, can be a sign of serious coronary disease.
Giving
blood pressure-lowering medications to those who have Type II, or
adult-onset, diabetes and peripheral arterial disease substantially
reduced the risk of heart attacks and strokes, the study says.
For
five years, the researchers followed 950 people with adult-onset
diabetes, including 53 with PAD.
Of
the 53 patients with PAD, 22 in an "intensive treatment"
group received the blood-pressure medications enalapril or
nisoldipine, and 31 in a "moderate treatment" group received
placebos. Among those who received the medications, three, or about 14
percent, had strokes or heart attacks, compared with 12, or nearly 39
percent, of those who did not take the medications.
"PAD
is very common, but it's under-recognized and under-treated,"
"It often presents itself as leg cramping during exercise, and
physicians don't tune in to it too much."
says Dr. William R. Hiatt, professor of medicine at the
University of Colorado Health Sciences Center.
Measuring
blood pressure in the ankle can provide a crucial early warning sign
of coronary disease -- and give physicians a chance to reduce the risk
of heart attack or stroke through intensive blood-pressure control,
the study found.
"The
point of this is if you've got [PAD] in your leg, it is a sign of
severe coronary disease, even in the absence of a heart attack,"
Hiatt says. "What we're discovering is if you treat those people
aggressively, you can prevent heart attack and stroke."
Researchers
also used the "ankle-brachial index," which compares the
blood flow in the arm and ankle arteries of patients, to detect PAD.
Those
in the moderate treatment group with PAD had an increased risk of
heart attack and stroke. However, those in the intensive treatment
group with PAD had no clinically relevant increased risk of either.
Hiatt
says the study provides more evidence of the importance of aggressive
blood-pressure control for diabetics. He adds the type of blood
pressure medication -- a calcium-channel blocker or
angiotensin-converting enzyme inhibitor -- did not matter.
Dr.
Michael Davidson, director of preventive cardiology at Rush Heart
Institute in Chicago, says the study's findings underscore the need
for aggressive treatment to lower blood pressure in PAD patients.
"Before
this study came out, there was kind of an impression that we should do
this, but now there is more evidence that we should do this,"
Davidson says.
"The
point is not just to treat the risk factors" for heart attack and
stroke, he said, "but to treat them aggressively. Just treating
them moderately may not be enough."
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