Q: My local senior center is sponsoring a test to check for "peripheral artery disease." The test is free, and they say it's safe and painless. Do you think it's a good idea?
A: Peripheral artery disease (PAD) is a form of atherosclerosis. In this case, cholesterol deposits produce blockages in the arteries that carry oxygen-rich blood to your legs. Mild blockages don't cause any symptoms, but more substantial disease can cause leg pain when you walk, which is called intermittent claudication. And severe narrowing will produce pain at rest or, worst of all, critical tissue damage that requires urgent surgery or even amputation. If that's not bad enough, PAD also indicates an increased risk for heart attacks and strokes.
About 8 million Americans have PAD, and the majority are men. Your doctor can screen for PAD simply by asking if you have symptoms and by feeling the pulses in your legs and feet. In addition, a painless, safe, simple test can detect PAD and estimate its severity. Called the ankle-brachial index, or ABI, it's simply a matter of using a special device to take blood pressure readings in your arms and legs, and then comparing the numbers.
Since PAD is common and can be serious, and since the ABI is simple, safe, and accurate, screening sounds like a no-brainer. Indeed, many experts recommend it -- but the authoritative United States Preventive Services Task Force (USPSTF) does not. They reason that everyone needs to pay attention to the root causes of atherosclerosis, including tobacco exposure, hypertension, unhealthy cholesterol levels, and lack of exercise. Since doctors and patients must work to improve these risk factors in any case, they argue, screening for PAD in asymptomatic people will add little beneficial information. Moreover, while testing may be safe and inexpensive, or even free, it may lead to treatments that are unnecessary, costly, and even risky.
At present, the USPSTF's position seems sound -- but new developments may modify the situation. Some new guidelines have changed important goals for patients with atherosclerosis. For example, the LDL ("bad") cholesterol goal has been lowered to 100 milligrams per deciliter (mg/dL) for folks with PAD instead of the usual 130 mg/dL. If studies show that ABI screening in asymptomatic people actually helps achieve these goals and better health, it may gain wider acceptance.
(Harvey B. Simon, M.D. is an Associate Professor of Medicine at Harvard Medical School and a member of the Health Sciences Technology Faculty at Massachusetts Institute of Technology. He is the founding editor of Harvard Men's Health Watch.)
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