The Risk Factors of PAD And How It Affects The Black Community By Dr. Yan Katsnelson, Founder and CEO, USA Vascular Centers.

While many people know to look out for signs of coronary artery disease, few are aware of the symptoms of peripheral artery disease, called PAD. Like coronary artery disease, PAD develops when plaque builds up in the arteries. But instead of plaque buildup (atherosclerosis) leading to the heart, the clogged arteries are those leading to the legs, feet, and ankles. 

PAD can cause a variety of problems. The first sign is often painful cramping in the legs when you’re doing something simple, such as climbing stairs or going out for a walk. The pain is a sign that the muscles in your legs aren’t getting enough oxygenated blood because of those clogged arteries. 

Over time, the cramping gets worse and other worrying symptoms can develop. Injuries to your feet and legs can take months to heal. Ulcers can develop, increasing the risk of gangrene and tissue death. Ultimately, PAD can increase your risk of amputation and even death, which is why it’s so worrying that the Black community is at a significantly higher risk of PAD than any other racial or ethnic group. Even worse, when compared with other groups, the medical system fails to diagnose and treat PAD in members of the Black community at a higher rate.1

Understanding PAD risk factors can help you identify early symptoms and receive the treatment you need. 

What Are the Risk Factors of PAD?

PAD risk factors can be divided into two categories: factors that you can control and factors you can’t. If other people in your family have PAD, stroke, or cardiovascular disease, you’re at a higher risk of developing PAD due to heredity. 

Another PAD risk factor you can’t control is age. The older you get, the higher your risk of PAD. If you have type 2 diabetes and atherosclerosis risk factors like high cholesterol or high blood pressure, your PAD risk is elevated even when you’re under 50. If you have atherosclerosis risk factors but not diabetes, PAD risk increases after age 50. 

Anyone who doesn’t fit in these categories begins to experience an increased PAD risk after the age of 65. In other words, everyone is at risk for PAD as they advance into their senior years.

PAD risk factors that most people can control include smoking, type 2 diabetes, high cholesterol, high blood pressure, and low or no physical activity. Each of these factors contributes to plaque building up in the arteries, which increases your risk of PAD, heart attack, and stroke.

How Is the Black Community Directly Impacted?

PAD is already an underdiagnosed and undertreated disease in the general population, and in the Black community, this is even truer. Worse still, Black Americans are also more likely to suffer from severe PAD complications, including amputation. While there are many reasons for this, researchers believe that structural racism plays a significant role. 

For example, even though the Black community experiences high blood pressure (hypertension) at a higher rate than any other group, the Black community also has the lowest treatment rate for hypertension. Hypertension is a direct risk factor for PAD, which means that thousands of Black Americans go without hypertension treatment that could help prevent PAD.

This lack of adequate diagnosis and treatment is due in part to implicit biases and systemic racism in the United States.2 Members of the Black community often lack the same access to healthcare and high-quality medical facilities that other groups, particularly white people, enjoy due to racist policies that reinforce gentrification, displacement, and poverty in the Black community. 

What Members of the Black Community Can Do To Prevent Pad

If you live with any of the PAD risk factors, it’s important to find a provider who will listen and take your concerns seriously. Looking for a Black primary care provider in your area is a good place to start.

Share concerns about resources with your primary care provider. They can give you recommendations to prevent PAD, helping you begin an exercise program and nutrition plan tailored to your needs. Ask your provider if you could benefit from medication to help control high blood pressure and high cholesterol. If you currently smoke, quitting is the single most important thing you can do to prevent PAD.

While prevention is ideal, early detection and treatment of peripheral artery disease can go a long way toward reducing complications of the disease. If you notice slowed toenail growth, patchy and slow-growing hair on your legs, and pain in your legs while walking, you could already have PAD. 

Diagnosing and Treating PAD in the Black Community

If you’re concerned that you have PAD, the culturally sensitive vascular doctors at USA Vascular Centers are here to help diagnose and treat peripheral artery disease. In addition to a physical examination, our doctors can perform one of several diagnostic tests, such as an ankle-brachial index (ABI) test, which measures and compares the blood pressure in your feet and arms. The resulting number can tell your physician if you may have PAD. 

Our doctors also perform angiograms. In an angiogram, one of our board-certified vascular doctors uses contrast dye and a minimally invasive catheter to locate blockages in the arteries leading to your legs. 

If you do have PAD, our doctors can create a personalized treatment plan. We specialize in minimally invasive, non-surgical procedures that open narrowed arteries. Angioplasty uses a balloon-tipped catheter to compress the plaque against artery walls. A stent placement adds the step of inserting a mesh stent into the artery to keep it from closing again. In an atherectomy, our doctors use a laser or tiny blade to safely remove plaque from the vascular system. 

Whether you want to learn more about the causes of peripheral artery disease, you need treatment for the condition, or you want to learn where to find a Black PAD physician, the team at USA Vascular Centers is here to help.

Sources Cited
1. III, Eddie L. Hackler, Eddie L. Hackler III Division of Cardiovascular Medicine, Naomi M. Hamburg, Naomi M. Hamburg Cardiology, Khendi T. White Solaru, Khendi T. White Solaru Correspondence to: Khendi T. White Solaru, For Disclosures, and Et Al. “Racial and Ethnic Disparities in Peripheral Artery Disease.” Circulation Research, June 10, 2021.

2. “Racial Discrimination in Healthcare.” How Structural Racism Affects Healthcare, June 15, 2021.