PAD and Heart Disease: Why the Two Are Closely Linked

When you receive a diagnosis of Peripheral Arterial Disease (PAD), the immediate focus is often on your legs—the pain when you walk, the coldness in your feet, or the risk of a non-healing wound. While managing these symptoms is crucial, it’s vital to understand that PAD is rarely just a “leg problem.” Instead, it’s a powerful red flag for a much larger, systemic issue affecting your entire circulatory system. The same disease process that is blocking the arteries in your legs is very likely also at work in the arteries of your heart and brain, making PAD and heart disease two sides of the same coin.

The link is so strong that having a PAD diagnosis significantly increases your risk of suffering a heart attack or stroke. This is because the underlying cause for all these conditions is the same: atherosclerosis. This systemic disease doesn’t just pick one part of the body to attack; it’s a widespread condition. Therefore, recognizing leg symptoms as a warning sign for your heart is one of the most important steps you can take to protect your overall health.

At Fox Vein and Vascular, we treat the patient, not just the limb. Dr. Fox, a board-certified vascular surgeon, emphasizes that a PAD diagnosis is a window into your total cardiovascular health. This guide will explore the deep connection between PAD and heart disease, explain the shared disease process, and outline why comprehensive vascular care is essential for both your legs and your life.

The Common Enemy: Atherosclerosis

To understand why PAD and heart disease are so closely linked, you must first understand their common cause. Atherosclerosis is a progressive disease characterized by the buildup of a waxy substance called plaque inside your arteries. This plaque is made up of cholesterol, fat, calcium, and other substances found in the blood.

Think of your arteries as a series of interconnected highways. Atherosclerosis is like a slow, steady traffic jam building up in multiple locations at once.

• When it occurs in the arteries supplying blood to your legs and feet, it’s called Peripheral Arterial Disease (PAD).
• When it occurs in the coronary arteries supplying blood to your heart muscle, it’s called Coronary Artery Disease (CAD), the most common type of heart disease.
• When it occurs in the carotid arteries supplying blood to your brain, it can lead to a stroke.

The plaque buildup is not a passive process. It begins when the smooth, delicate inner lining of the artery, the endothelium, is damaged. This damage can be caused by a variety of factors, creating a rough patch where cholesterol can begin to stick, initiating a chronic inflammatory response that leads to plaque growth. Over time, this plaque can grow large enough to narrow the artery and restrict blood flow, or it can become unstable and rupture.

Shared Risk Factors: Fueling the Fire

PAD and heart disease don’t just share a common mechanism; they share the exact same set of risk factors. These are the lifestyle and genetic elements that damage the endothelium and promote the development of atherosclerosis throughout the body. If you have risk factors for one, you have them for the other.

Smoking

This is the single most powerful and preventable risk factor for both PAD and heart disease. The thousands of toxic chemicals in cigarette smoke directly injure the endothelial lining, promote inflammation, increase “bad” cholesterol, and make blood thicker and more prone to clotting. A smoker’s entire arterial system is under constant attack.

Diabetes

High blood sugar levels create a toxic environment for blood vessels. Diabetes accelerates atherosclerosis by increasing inflammation, damaging the artery walls, and altering cholesterol levels. The presence of diabetes dramatically increases the risk and severity of both PAD and heart disease. It’s a key reason why patients develop complications like a diabetic foot ulcer/wound.

High Blood Pressure (Hypertension)

Think of high blood pressure as a constant, hammering force against your artery walls. This relentless pressure causes mechanical stress and injury to the endothelium, creating more sites for plaque to form.

High Cholesterol

High levels of LDL (“bad”) cholesterol in the blood provide the raw material for plaque. When the endothelium is damaged, these cholesterol particles can burrow into the artery wall, becoming a core component of the growing blockage.

Advancing Age

As we age, our arteries naturally become stiffer and more susceptible to damage, a process known as arteriosclerosis. The cumulative effect of decades of exposure to other risk factors means that atherosclerosis is much more common in individuals over 60.

Family History

A family history of early-onset PAD or heart disease suggests a genetic predisposition to developing atherosclerosis, making it even more important to control the risk factors you can change.

Because these risk factors affect the entire body, it’s rare for atherosclerosis to be confined to a single area. It is a systemic disease. That’s why a diagnosis of PAD is such a potent predictor of heart disease.

How a Leg Problem Signals a Heart Problem

When a patient is diagnosed with PAD, it tells a vascular specialist something profound: the atherosclerotic burden in that patient’s body is significant enough to cause symptoms. If the arteries in the legs—which are large and robust—are blocked enough to cause leg pain when walking (claudication), it is highly probable that the smaller, more critical arteries of the heart are also affected.

Studies have shown that patients with PAD have a much higher risk of cardiovascular events:

• Increased Heart Attack Risk: People with PAD have a 20-60% increased risk of heart attack compared to those without it.
• Increased Stroke Risk: The risk of stroke is also significantly elevated.
• Higher Mortality: PAD is an independent predictor of cardiovascular mortality. Patients with PAD are at a much higher risk of dying from a heart-related event than from a PAD-related complication like amputation.

The Unstable Plaque: A Threat Everywhere

The greatest danger from atherosclerosis comes from plaque rupture. The plaque deposits are not always stable; some have a thin, fibrous cap over a soft, lipid-rich core. If this cap breaks, the body perceives it as an injury and forms a blood clot on the plaque’s surface.

• In the heart: If a plaque ruptures in a coronary artery, the resulting blood clot can completely block blood flow to a portion of the heart muscle. This is a heart attack (myocardial infarction).
• In the legs: A similar event in a leg artery can cause acute limb ischemia, a sudden loss of blood flow that causes severe pain and can lead to gangrene and amputation if not treated immediately.

Because the nature of plaque is often similar throughout the body, a person with unstable plaque in their leg arteries likely has unstable plaque in their heart arteries as well.

The Importance of a Dual-Focus Approach

This powerful link means that treatment cannot focus on just the legs in isolation. A diagnosis of PAD should trigger a comprehensive cardiovascular risk assessment. At Fox Vein and Vascular, our approach extends beyond treating leg circulation problems.

Step 1: Accurate PAD Diagnosis and Treatment

First, we must address the immediate problem. A thorough PAD diagnosis is essential. Our in-office vascular lab in Manhattan provides a complete, non-invasive workup.

• Ankle-Brachial Index (ABI): A simple screening test to confirm reduced blood flow.
• Duplex Ultrasound: This allows Dr. Fox to visualize the blocked leg arteries and plan the best intervention. You can learn more about our state-of-the-art diagnostics here.

Based on the findings, a Peripheral Arterial Disease treatment plan is created. For many patients, this involves minimally invasive treatments for PAD, such as:

• Angioplasty for PAD: Using a balloon to open the artery.
• Atherectomy Procedure: Physically removing the plaque.
• Stenting for PAD: Placing a scaffold to keep the artery open.

These procedures restore blood flow to the legs, relieving pain, healing ulcers, and preventing amputation. We serve patients from the 5 Boroughs, Nassau, Suffolk, South Western Ct., and North East NJ, providing expert amputation prevention services.

Step 2: Aggressive Systemic Risk Reduction

This is the heart-protective part of the treatment. Once PAD is diagnosed, we work with the patient and their primary care physician or cardiologist to implement aggressive risk factor modification.

• Medication Management: This almost always includes a statin to lower cholesterol and stabilize plaque, an antiplatelet agent (like aspirin) to prevent blood clots, and medications to control blood pressure.
• Lifestyle Overhaul: This includes a structured smoking cessation program, a heart-healthy diet, and a supervised exercise program.
• Diabetes Control: For diabetic patients, maintaining strict control of blood sugar is paramount.

By treating the systemic disease of atherosclerosis, we are simultaneously treating the PAD and reducing the future risk of heart attack and stroke.

A Note on Other Vascular Conditions

The expertise used to manage systemic atherosclerosis is also being applied to other vascular-related issues. For instance, chronic knee pain from knee osteoarthritis is often driven by inflammation fed by tiny arteries around the joint. An innovative GAE knee pain treatment called Genicular Artery Embolization uses catheter skills similar to those in PAD treatment to block these inflammatory vessels, providing non-surgical knee pain relief. This highlights how a deep understanding of the vascular system can solve problems beyond traditional blockages.

Don’t Ignore the Warning from Your Legs

If you have been diagnosed with PAD, or if you are experiencing symptoms like leg pain, numbness, or non-healing wounds, it is imperative that you see it as more than a local problem. Your legs are sending a crucial warning signal about the health of your entire cardiovascular system.

Conversely, if you have known heart disease, you should be aware of your increased risk for PAD and be vigilant for leg symptoms. A comprehensive approach to your vascular health is the best way to protect yourself from the full spectrum of atherosclerotic disease.

Treating your PAD is not just about saving your leg; it’s a critical step in a strategy to save your life. By choosing a vascular surgeon in Manhattan like Dr. Fox, who understands this deep connection, you are ensuring that your care plan addresses both your immediate symptoms and your long-term cardiovascular risk.

Schedule a comprehensive vascular evaluation with Dr. Fox today. It’s a vital step for the health of your legs and your heart.

Fox Vein and Vascular – Manhattan, NY
📞 (212) 362-3470
🌐 foxvein.com
📍 1041 Third Avenue, New York, NY 10065