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Risk Factors

Illustration showing gradual clogging of arteries

Risk Factors for Peripheral Vascular Disease

Arteries are similar to a plumbing system that can begin to clog with time. This happens when plaque builds up within the arteries, preventing the delivery of blood to tissues and organs supplied by the affected artery. Body tissues can die due to this loss of blood supply and the nutrients and oxygen it carries, if a critical artery clogs up completely. This disease is called atherosclerosis. Sometimes the term "hardening of the arteries" is used; however, this is really a colloquial name that originally referred to disease of smaller vessels (arteriosclerosis), but is used incorrectly to refer to atherosclerosis.

Risk Factors that Cannot be Changed

There are several risk factors for heart and vascular disease. Certain risk factors cannot be changed, such as:

  • Family medical history
  • Gender (men are at higher risk than women until women reach menopause; then the risk is the same)
  • Age

However, there are several important risk factors that can be changed. These provide every patient with an opportunity to lower his or her risk for atherosclerosis by modifying lifestyle.

Illustration of man carrying a backpack of risk factors

Risk Factors that Can be Changed

Smoking cigarettes: Although smoking has been associated with lung cancer, it also increases the risk of heart disease and peripheral vascular disease (disease in the vessels that supply blood to the arms and legs). Although nicotine is the main active agent in cigarette smoke, other chemicals and compounds like tar and carbon monoxide are also harmful to the heart and blood vessels. Smoking may raise the blood pressure, which increases the risk of stroke in people who already have high blood pressure. Chemicals in cigarette and tobacco smoke lead to the buildup of fatty plaque in the arteries, possibly by injuring the vessel walls.

Elevated cholesterol: One of the major risk factors for heart and vascular disease is high blood cholesterol. Cholesterol, a fat-like substance carried in the blood, is found in most of the body's cells. The liver produces cholesterol to form cell membranes and to manufacture certain hormones. Extra cholesterol enters the body when a person consumes foods that come from animals (meats, eggs, and dairy products). Although people often blame the cholesterol found in foods for raising blood cholesterol, it is really the saturated fat in food, not the cholesterol, per se. Even though a food does not contain cholesterol, it may still have large amounts of saturated fat. Foods rich in saturated fat include butterfat in milk products and fat from red meat. Eating trans fats found in some commercially baked cookies and crackers can also raise your cholesterol. Too much low-density lipoprotein (LDL or "bad cholesterol") in the blood causes plaque to form on artery walls, which initiates atherosclerosis.

Obesity: Extra weight is thought to lead to increased total cholesterol levels, high blood pressure, and an increased risk of coronary artery disease. Obesity increases a patient's chances of developing other risk factors for heart disease, especially high blood pressure, high blood cholesterol, and diabetes. Many doctors now measure obesity in terms of body mass index (BMI), which is a formula of kilograms divided by height in meters squared (BMI =W [kg]/H [m2]). According to the National Heart, Lung and Blood Institute, being overweight is defined as having a BMI over 25. Those with a number over 30 are considered obese.

Diabetes: Heart and vascular problems are the leading cause of death among people with diabetes, especially in the case of adult-onset or Type II diabetes (also known as non-insulin-dependent diabetes). Certain racial and ethnic groups (African-Americans, Hispanics, Asian and Pacific Islanders, and Native Americans) have a greater risk of developing diabetes. If a person has diabetes, he or she may already be aware that good control of blood sugar levels can reduce the risk of cardiac and vascular disease.

Hypertension (high blood pressure): High blood pressure increases the risk of heart disease, heart attack, peripheral vascular disease, and stroke. Though other risk factors can lead to high blood pressure, it may occur in the absence of other risk factors. Combining obesity, smoking, and high cholesterol with high blood pressure increases a patient's risk substantially. Blood pressure can vary with activity and with age, but a healthy adult who is resting generally has a systolic pressure reading between 120 and 130 and a diastolic pressure reading between 80 and 90 (or below). Inactive lifestyle: People who are not active have a greater risk of heart and vascular disease than people who exercise on a routine basis. Exercise not only burns calories, helps to control cholesterol levels and diabetes, but also may actually lower a person's blood pressure. Exercise helps to preserve the flexibility of peripheral blood vessels.

Stress: Stress is considered a contributing risk factor for heart and vascular disease, although little is known about how stress exerts an influence on the cardiovascular system. The effects of emotional stress, behavior habits, and socioeconomic status on the risk of heart disease and heart attack have not been proven. That is because people deal with stress differently so there is no predictable outcome for patients experiencing stress.

Eliminating Risk Factors

The elimination of certain risk factors can help alleviate symptoms:

Stop smoking completely: quitting for one year reduces the risk of coronary heart disease by half; quitting for one day returns pulse and blood pressure to normal.

Check cholesterol levels: lowering of serum cholesterol is beneficial in patients with known atherosclerosis; every 10% reduction in cholesterol translates into a 12-16% decrease in mortality for patients with coronary artery disease.

Maintain healthy body weight: the less you weigh, the less weight the legs have to carry, which reduces muscular stress and diminishes pain and fatigue.

Eat a well-balanced healthy diet, rich in vegetables and fruits: low-fat diets are the rule for those who wish to decrease the buildup of arterial plaque. Exercise regularly: low-to-moderate intensity activities for as little as 30 minutes a day can be beneficial. These activities may include:

  • Pleasure walking
  • Climbing stairs
  • Gardening
  • Yard work
  • Moderate-to-heavy housework
  • Dancing
  • Home exercise

See a doctor for diabetes and hypertension control: undetected and uncontrolled diabetes is a major problem. Adequate control of diabetes with diet, tablets, insulin injections, and exercise is important. Goals for hypertension control generally include the following:

  • Less than 140/90 mm Hg
  • Less than 135/85 mm Hg in diabetics
  • Initiate lifestyle modification in all patients with hypertension
  • Drug therapy whenever required
  • Remain always on the alert for peripheral vascular disease, especially if there are any family traits concerning poor circulation or heart disease

Remember …
Reducing or eliminating risk factors is always a good approach, whether patients have symptoms of cardiovascular disease or not. However, many patients may need some type of surgical or endovascular intervention, even if they are successful at lowering their blood pressure, reducing their cholesterol levels, or controlling their diabetes.