Peripheral Arterial Disease
Then incidence of large vessel arterial disease is affected by many things including lifestyle, genetic predisposition, age and socio-economic status. Approximately 20% of the general population over 60 years of age will have some form of vascular problem. It is more common in men, however there is an increase in its incidence in post-menopausal women. This rate increases further with age. Most people will be unaware that they have arterial disease as they will not have symptoms, while interventional treatment is only required in a small minority. The cause of vascular disease is not precisely known. However, there are specific medical or biological conditions, plus aspects of people's lifestyle, that are strongly associated with or known to promote the development of vascular disease. These are known as risk factors, and if they are not eliminated or controlled, the extent and severity of vascular disease may increase over time. In many cases the disease process can be stabilised once risk factors are eliminated or controlled.
Risk factors for arterial disease include:
- Smoking: The greatest risk factor for developing vascular disease is tobacco consumption. Smoking in any form severely compromises blood flow in several ways, including making the walls of the artery shrink (spasm) and eventually stiffen. The multitude of chemicals and toxins in tobacco may also cause the blood to thicken and at the same time make the artery wall sticky, both of which cause the blood to clot.
- Abnormal blood cholesterol levels (hyperlipodaemia): Not all fats are bad. Excessive long term consumption of foods high in bad cholesterol or saturated fats results in the accumulation of "fatty streaks" within the fine inner layer of the wall of the artery. If this goes unchecked, the lesions change their structure, enlarge and are known as atherosclerosclerotic plaque. In time plaque protrudes in to the artery narrowing the opening which may restrict blood flow. It also results in the lining becoming irregular, which increases the risk of blood clot formation. Finally, pieces from unstable plaque may break off and block smaller arteries upstream.
- High blood pressure (hypertension): Uncontrolled hypertension may also damage the lining of the artery, increasing the risk of developing both narrowing and an aneurysm. Hypertensive episodes on their own are known to cause strokes.
- Diabetes: There is a very strong association between diabetes and vascular disease. Although the mechanism is not clearly understood, diabetes appears to damage the tissues that line blood vessels, increase blood clotting, increase cholesterol levels, and alter the way white blood cells function.
- Family History of Arterial Disease: The genetic predisposition to vascular disease is significant. If someone has a family history of a stroke or heart disease, there is a chance that they may suffer the same fate. However, controlling the other risk factors is extremely helpful in reducing the likelihood of this occurring. Aneurysms of the main artery that leaves the heart, the aorta, are very commonly seen in men of the same family. All direct male relatives, i.e. sons or brothers should be screened with ultrasound.
- Other Issues: Men are more likely to develop vascular disease particularly those over 55 years of age. Physical inactivity, being overweight, a poor diet, excessive alcohol consumption and kidney disease have also been shown to contribute to the development of vascular disease.
The effects of risk factors are interrelated and controlling or eliminating them has many advantages. Not only will this reduce the likelihood of further vascular problems, it may also decrease the affects of the disease and importantly, maintains the effectiveness of any treatment. The single most important thing that any patient can do is stop smoking. You should reduce the amount of total fat, particularly saturated fats, in your diet and if you are prescribed medication, ensure that you use it appropriately and have regular blood tests. Diabetics should be especially careful to follow medical advice regarding diet, treatment and medication. Similarly, hypertension needs to be monitored closely. Regular moderate exercise is invaluable as it can counteract the effects of all risk factors.