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WHAT IS IT?
You have peripheral vascular disease when arteries some distance from the center of your body-in your legs, or less often your arms or neck-become clogged with fatty deposits called plaque. This makes it hard for blood to get through to your muscles. When muscles don’t get enough oxygen from the blood, they let you know with pain, cramps, or numbness. This happens most often when you work hard-for example, your legs might ache when you climb stairs.

Peripheral vascular disease, or PVD, is not often dangerous, but sometimes it can lead to big problems. Untreated PVD can even slow blood flow so much that tissues begin to die. Worse, if you have PVD, you are also likely to have coronary artery disease-clogs in the arteries that supply blood to the heart. And this can lead to a heart attack.

The good news? You can do a lot to prevent PVD by making smart choices about such things as your diet and exercise habits. If you already have it, you and your doctor can begin to treat the problem-and even reverse it.
WHAT IS HAPPENING?
All the muscles, tissues, and organs in your body need a constant supply of oxygen to work well. Your blood picks up oxygen in your lungs. Then your heart pumps this blood throughout your body by way of a network of vessels called arteries.

Healthy arteries are smooth inside, so blood flows through them easily. But they can become diseased when cholesterol, a fatlike substance carried in the blood, begins to streak the vessel walls. Over time, these streaks build up, like rust in a pipe, and harden into plaque.

This slow clogging is called atherosclerosis. It may begin in the late teens and keep getting worse for years. Symptoms such as pain don’t show up until the arteries are already badly narrowed. The symptoms depend on which arteries are narrowed, and where. If an artery in your heart is clogged, you might feel angina pectoris-chest pain. If an artery in your leg is blocked, you might feel numbness or pain there. The symptoms mean your muscles, nerves, and other tissues aren’t getting enough oxygen.
WHAT CAUSES IT?
You can’t do much about some of the things that increase your risk for peripheral vascular disease, such as your age, sex, and family history. But you can do a lot about other risk factors.

THINGS YOU CAN’T CHANGE

Gender
Many people think only men have to worry about clogged arteries. In fact, a woman does have a lower risk than a man-until she reaches menopause. Before then, the female hormone estrogen protects her arteries. But after menopause, estrogen levels drop, and a woman’s risk rises quickly to that of a man.

Age
Peripheral vascular disease most often affects older people. About 12 percent of those age 65 to 70 have the disease, as do 20 percent of those older than 70. But most have no symptoms.

Family
Artery disease runs in families. If your mother or father has it, you likely have a higher risk than someone from a family in which no one has artery disease. Having a grandparent, aunt, or uncle with the problem raises your risk, too, but not as much.

THINGS YOU CAN CHANGE

Smoking
Smoking is one of the worst things you can do to your arteries. It’s the biggest single risk factor for peripheral vascular disease. The nicotine and chemicals in smoke damage the insides of your blood vessels and raise your cholesterol and blood pressure levels, increasing your risk of clogged arteries. A man who smokes a pack a day has twice the risk of artery problems as a nonsmoker. If you’re a woman, smoking is even more dangerous-a pack a day raises your risk five to 10 times. Worse yet, your risk for lung cancer also shoots up if you smoke.

High blood pressure
Blood pressure is the force with which blood pushes against artery walls as it flows. The pressure rises and falls throughout the day, but if it’s higher than normal most of the time, it can cause a lot of health problems. That’s because high blood pressure roughens artery walls. This makes it easier for plaque to form and clog arteries.

Two numbers written one above the other measure blood pressure. The top number is systolic pressure, measured when the heart squeezes blood out to the rest of the body. The bottom is diastolic pressure, measured when the heart relaxes between beats and refills with blood.

Your risk for problems begins to rise when your blood pressure goes up. Some experts think that even if your blood pressure is in the normal range, the lower it is the better off you are.

Being overweight
If you weigh more than you should, your risk of PVD goes up. Too much weight puts constant strain on your heart and raises blood pressure and cholesterol.

Too much fat and cholesterol
The more fat and cholesterol in the foods you eat, the faster your arteries are likely to narrow.

Lack of exercise
The less active you are, the higher your risk of PVD. But the better shape you’re in, the healthier your arteries will be. That’s because regular exercise helps keep your arteries flexible and open.

Too much alcohol
Heavy drinking raises blood pressure and damages the heart muscle, which then can’t pump as much blood as your body needs.

Diabetes
Your risk of PVD goes up if you have diabetes. The reasons are complex, but experts think diabetes tends to promote the buildup of plaque on artery walls.
WHAT YOU CAN DO FOR YOURSELF
You can do a lot to prevent PVD. If you already have it, you can do much to keep it from causing problems, and to help your arteries recover.

Foot care
Because PVD blocks blood flow, less blood and fewer infection-fighting white blood cells are moving through your body. So PVD makes infections more likely and harder to heal.

Caring for your feet can help prevent trouble. Inspect your feet every day, looking for trouble spots such as blisters or cuts. Treat a blister or cut promptly. Clean the sore with hydrogen peroxide-you can buy it at the drugstore-then keep the sore dry and air it out. If you notice an infection on your foot, call your doctor right away. Other foot care tips:

Wash your feet daily with warm water and soap.
Pat your feet dry-don’t rub.
Use skin lotion. Avoid getting lotion between toes.
Don’t walk around barefoot.
Wear clean socks every day.
Wear shoes that fit well.
Don’t wear new shoes for more than an hour at a time until they’re broken in.
Don’t sit with your legs crossed.
Use lamb’s wool between your toes if they rub against each other.
Before you cut your toenails, soak them in warm water for 10 minutes. Cut each nail straight across. Avoid cutting corners or close to the skin.
Don’t treat calluses or corns without first calling your doctor.
Exercise
Exercise helps prevent PVD. And if you already have it, exercise will help speed your recovery.

How does it work? First of all, exercise may help open up clogged arteries, or keep clots from blocking blood flow. Exercise also lowers blood pressure and helps keep off extra weight. For the same reasons, exercise can also help protect you from a heart attack.

The idea of exercising after finding out you have peripheral vascular disease may be a little scary, but if anything, exercise is even more important then. In fact, if you have PVD, your doctor will probably give you a special exercise plan that includes plenty of walking or biking. Tips to make it safe and easy:

Almost any activity is better than none, but for PVD, walking or biking are best of all. Start by being a bit more active each day. Any activity will help; even brief workouts will lower your blood pressure and cholesterol. Take the stairs instead of the elevator. Walk the dog for 15 minutes each evening; your pooch and your blood vessels will thank you.
If you have PVD, your legs might hurt at first. If so, stop and rest until the pain goes away. Then walk a little farther.
When you’re used to being active, add some activities that are more aerobic to your routine. These should make you breathe harder and sweat a bit, and get your heart pumping. Brisk walking, running, biking, and swimming are all ideal. Take a couple of months to work up to 20 to 30 minutes at a time most days of the week.
Almost any exercise is better than none, but if you have high blood pressure, until it’s under control avoid pushing and straining, as in weight lifting. If you do move on to lifting weights, don’t hold your breath as you lift.
Find something you enjoy-it’s easier to keep exercising when you like to do it.
If you have symptoms of angina or a heart attack while exercising, stop and call 911 right away.
Eat the right stuff
A low-fat, low-cholesterol diet can help prevent and even reverse PVD.

You do need some fat and cholesterol to stay healthy. They provide energy, maintain cell walls, and help your body make hormones, including sex hormones such as testosterone and estrogen. And some oils such as canola, safflower, and olive oil contain substances that may help protect the arteries. But when you eat extra fat, especially the wrong kinds of fat, or when you eat extra cholesterol, your body stores some of these substances as body fat, and some of them end up clogging your arteries. If you have high blood pressure, then the fat and cholesterol in your food can turn into an even bigger problem. That’s because high blood pressure roughens artery walls, so plaque-fatty lumps that can grow and harden over time-is more likely to stick and build up.

Cholesterol is a waxy substance found only in foods from animals. Your liver makes all you need. Eating extra cholesterol is one cause of artery disease. But it isn’t the only cause, or even the main one-fat is. While all fats are fattening, some are worse for your arteries and heart than others.

Saturated fats come from animals and some plants, including palms and coconuts. These fats are solid at room temperature. They raise cholesterol levels in your blood and clog your arteries.

Hydrogenated vegetable oils are oils that food manufacturers have turned into saturated fats. They’re found in margarine, vegetable shortening, and many packaged foods. They clog your arteries just as saturated fats do. Hydrogenated vegetable oils also contain a form of fat called trans fatty acid, which appears to raise the level of low-density lipoprotein (LDL), the so-called bad cholesterol that clogs arteries, and lower the level of high-density lipoprotein (HDL), the good kind.

Unsaturated fats come from plants and fish, and are liquid at room temperature. They come in two types: polyunsaturated and monounsaturated. Most vegetable oils are a mix of the two. Olive and canola oils are mostly monounsaturated fat. They slightly lower LDL and slightly raise HDL. Sunflower, safflower, and soybean oils are mostly polyunsaturated fat. They lower LDL, but appear to slightly lower HDL as well. Fish oils and flax seed oil contain a special type of fat, Omega-3s, which appears to prevent blood clots and lower the risk of heart attack.

If you use fat in cooking, use liquid vegetable oils as much as possible, but remember that too much of any type of fat is fattening.

Here are some simple things you can do to cut fat and cholesterol in your diet:

Read food labels to know what you’re getting. The important things to look for are calories, calories from fat, total fat, saturated fat, and cholesterol. Also, note if “hydrogenated” or “partially hydrogenated” vegetable oil is on the list of ingredients and try to steer clear of foods that contain it. The American Heart Association advises keeping your fat intake under 30 percent of your total calories each day. That could mean only 750 calories a day, or even fewer, from fat. (Just one tablespoon of butter has about 100 calories.) Not everyone agrees with the 30 percent recommendation, however. Some experts think you should go for 20 percent or less, while others say if you’re trim and lean, you can be healthy if you get as much as 40 percent of your daily calories from fat, as long as most of this fat is the unsaturated kind.
Build your meals around fruits, vegetables, and grains. They have little fat and no cholesterol and are loaded with vitamins, minerals, and fiber. Fiber is important. It lowers cholesterol and blood pressure and helps keep your arteries open. Foods rich in fiber include apples, oranges, potatoes, squash, peas, carrots, soybeans and other beans, oats, and barley.
If you eat red meat, make it a once-in-a-while treat, not a regular item, and keep it lean. Look for cuts graded “select,” which means they have the least fat. Other low-fat cuts include pork loin, lean center-cut ham, venison, veal chops or roast, and lamb flank. Before cooking chicken, remove the skin and fat. Don’t use chicken injected with salt and fat-read the package label to make sure it isn’t. Eat no more than six ounces of meat, poultry, or fish a day. Keep servings to three ounces-a cut of meat about the size of a deck of cards, half a skinless chicken breast or leg, or three-fourths cup of flaked fish.
Some studies suggest that eating fish two or three times a week can lower your risk of heart attack. While fish may be important, the way you cook it is even more so. Broil, instead of frying or sauteing in butter or oil.
Don’t fry foods. Bake, broil, steam, or saute with water or vegetable broth in a nonstick pan.
If you eat dairy foods, go for low- or nonfat versions such as skim or 1 percent milk, and choose nonfat yogurt, ice milk, or sherbet instead of ice cream.
Egg yolks contain a lot of cholesterol. Eat no more than three or four a week, including eggs in baked goods. In recipes, replace one whole egg with two egg whites or use an egg substitute.
For salads, try an oil-free dressing. If you use oil, make it one high in unsaturated fats, such as olive, canola, safflower, or sunflower.
Read the labels on frozen dinners to see how much fat they contain. Aim for meals that have less than 10 grams of fat per serving.
Other diet changes that help
Use less salt. The body needs only about 200 milligrams of sodium a day, but most of us get much more than even the very generous 2,400 mg recommended by most health experts (the amount in about one teaspoon of salt). Too much sodium makes your body hold water and other fluids. If you already have high blood pressure, extra fluid may raise it even higher. But people react to salt differently. Some can eat salty foods with no effect on their blood pressure. For others, eating the same foods will make their blood pressure shoot up. If you have high blood pressure and you know salt is a problem for you, watch out for canned and prepackaged foods. Many are loaded with salt-much more, in fact, than the amounts people usually sprinkle on food at the table. Also steer clear of potato chips, pizza, fast foods, frozen dinners, and processed meats. And don’t put extra salt on your food.
Get plenty of vitamins B-6, B-12, C and E, folic acid, and the minerals calcium, magnesium, and potassium; they’re necessary for a healthy heart and arteries. A varied diet provides all you need, but if you want to be sure, take a daily multivitamin that contains recommended amounts.
Calcium and potassium may help. People who get plenty of calcium and potassium from their foods tend to have lower blood pressures that those who don’t get enough of either.
Aim for at least the minimum daily allowance of 1,000 milligrams of calcium every day (or 1,200 mg if you’re over 50). Good calcium sources include dairy products, green leafy vegetables, tofu, soybeans, and canned sardines and salmon. If your diet is typical, you’ll probably need a calcium supplement. It’s best to take small doses of less than 500 mg with meals. Calcium carbonate, as found in Tums or Rolaids, is a good choice.

There’s no RDA for potassium, but experts suggest at least 3,500 mg a day. You’ll get plenty if you stick to a well-balanced diet with lots of fruits and vegetables. Good sources of potassium include avocados, bananas, oranges, dried apricots, prunes, spinach, potatoes, milk, and lentils. If you’re concerned about getting enough, though, consider potassium supplements: one 500 mg pill in the morning and another 500 mg at night.

Be careful with alcohol
Studies show that moderate drinking may help cut the risk of cardiovascular disease slightly. On the other hand, too much alcohol can raise your blood pressure and cause heart problems. If you drink, don’t drink much. A rule of thumb for men is no more than two drinks a day; for women, no more than one. A drink is one bottle of beer (12 ounces), one glass of wine (5 ounces), or one jigger of hard liquor (1.5 ounces).

Control your weight
Start dropping any extra weight. This will help improve blood flow and lower blood pressure. Don’t go on a “crash” diet, though-most crash dieters gain back any weight they’ve lost. The best approach? Combine smart eating with exercise.

Extra calories-those you don’t use for energy right away-pack on the pounds. Exercise burns them off. To lose a pound of fat, you need to use 3,500 more calories than you take in. That’s because one pound of fat has 3,500 calories. (A typical fast-food lunch of a burger, fries, and a shake is loaded with about 1,700 calories; by contrast, an apple has only 80.)

Taking off weight may sound daunting, but it doesn’t have to be. Here are some tips for a program that works:

Check with your doctor to find out how much you ought to weigh.
Take your time. When you lose weight slowly-no more than 1 percent of your body weight each week-it’s easier to keep it off.
Be realistic. Don’t aim for a weight you can’t reach and maintain. Even a little weight loss will help lower your risk of problems, even if you never reach your ideal weight.
Keep an eye on your total calories and cut down on fats. Follow the dietary guidelines above.
“Fat-free” and “low-fat” foods can be a trap. They may not have the fat, but many of them make up for it with sugar, so they’re still high in calories.
Stay as active as you can.
Don’t stress out
Too much stress can harm your health, and it can be very hard on your heart and arteries. Your natural response to a demanding or high-pressure event-a problem at work, a wedding, even getting ready for a vacation-causes changes in your body. Your heart starts to beat faster, and your body releases a number of “fight or flight” chemicals that provide quick energy. Your blood pressure also shoots up, and that can be bad if yours is already too high.

Brief bouts of stress aren’t harmful, but a lot of stress day after day can take a toll. Built-up stress raises your risk of heart and artery disease, as well as your risk of a number of other health problems, including depression and headaches.

Here are some tips for staying on an even keel, even in those stressful times:

Exercise. People who exercise often feel less anxious and more relaxed.
Laugh more. Studies show that laughter releases stress-busting hormones.
Don’t be a perfectionist. Set reasonable goals and question whether everything you do has to be the best.
Control your anger. When you’re angry, ask yourself three questions: Is this problem important? Is my anger justified? Can I do anything to fix the problem? If the answer to any of the three is no, take a few deep breaths and tell yourself to calm down. If any answer is yes, don’t seethe silently; figure out something you can do to change the situation.
Take breaks during a hectic day to calm down. It doesn’t matter what you do-walk around, chat with someone, water some plants-as long as it’s a time-out. Aim for at least 20 minutes a couple of times a day.
Keep a pet. They may shed and slobber, but studies show their owners have fewer health problems than people without pets.
Relax through yoga, deep breathing, stretching exercises, or meditation.
Lower your blood pressure
Blood pressure is measured with a device that records two numbers, written one above the other. The top number is systolic pressure, the peak pressure when your heart squeezes blood out to the rest of the body. The bottom number is diastolic pressure, the pressure when your heart relaxes between beats and refills with blood.

Doctors divide blood pressure into levels of risk. They define normal blood pressure as less than 130/85, but some experts think your risk for problems begins to go up even when your blood pressure is still “normal” but above the ideal, 110/70. The higher it is, the higher your risk for disease, and the harder it is to bring down to healthier levels.

When your blood pressure reaches Stage 1 (140/90) or goes higher, then you have what doctors call high blood pressure. They strongly urge lifestyle changes and perhaps treatment to bring it down. Follow the guidelines here for diet, exercise, weight loss, and stress reduction. If your doctor prescribes medications for high blood pressure, be sure to take them. You may not be able to get it down to the ideal, but even a little lower will help.

Don’t smoke
While your risk for many serious health problems shoots up with the first puff, there’s good news: As soon as you’ve taken your last puff, your body begins to recover. For instance, within a year, your risk for heart disease drops to half that of a smoker. And 15 years after stopping, your risk is the same as that of a person who never smoked.

Manage your diabetes
If you have diabetes, you can’t change that fact. But you can reduce your risk of artery disease, heart attack, and stroke. Work with your doctor to manage it with exercise, the right foods, and medications.

Stay involved
Friendships can do wonders for your health. Studies show that frequent contact with others cuts your risk for many kinds of disease. Volunteer, join community groups, take classes, and visit your friends. If you have peripheral vascular disease, join a support group to talk with people who know what you’re going through. You’ll learn more about recovery and treatments, and make some new friends.
WHAT YOUR DOCTOR CAN DO FOR YOU
Sometimes lifestyle changes aren’t enough to cure peripheral vascular disease. Your doctor may recommend medications or other treatments.

Pentoxifylline
Improves blood flow and reduces pain caused by poor circulation.

Pro
Works well to help patients walk farther by preventing leg cramps.
Con
You may not be able to tell for several weeks whether the drug is working.
May cause headaches, dizziness, stomach upset, fatigue, and-rarely-chest pain and uneven heartbeat.
Anticoagulants
These drugs help prevent blood clots from developing in arteries affected by atherosclerosis.

Pro
Can ease the symptoms of PVD and may help prevent heart attack and stroke.
Con
May cause dizziness, headaches, nausea, stomach cramps, diarrhea, and vomiting.
Aspirin
If you have peripheral vascular disease, your risk for heart attack and stroke go way up. Aspirin cuts your risk by making blood clots in arteries less likely. Studies also show that if you do have a heart attack, it won’t be as severe if you’ve been taking aspirin. Aspirin also lowers the risk of stroke. Experts recommend a half or whole (325 mg) aspirin tablet every day if you’re a man age 50 or older or a woman past menopause with at least one additional risk factor for heart disease, such as high blood pressure or high cholesterol. But aspirin isn’t for everyone; don’t start taking it without talking to your doctor first.

Pro
Inexpensive.
Con
Can cause stomach upset. Your doctor may suggest an enteric-coated brand that delays release of the drug until it has passed through your stomach.
Can worsen liver or kidney disease, an ulcer, high blood pressure, asthma, or bleeding problems such as hemophilia.
Can increase bleeding. Stop taking aspirin about five days before any surgery, including oral surgery. But talk to your doctor before quitting if you know you have artery problems.
Can trigger asthma attacks in 5 to 10 percent of people with asthma.
Angioplasty
The American Heart Association suggests this operation if:

Your legs hurt when you walk even after lifestyle changes or medical treatment.
You want to be more mobile than these treatments allow.
You don’t exercise or you continue to smoke.
Angioplasty is the most common procedure for artery disease. A thin, hollow, flexible wire called a catheter is threaded into a clogged artery. A tiny balloon at the end of the catheter inflates inside the artery, and pressure from the balloon flattens plaque and fatty deposits. Sometimes, a wire mesh tube called a stent is inserted into the artery and left in place after the balloon is removed. It helps keep plaque from reclogging the artery. Scientists are also experimenting with brief doses of radiation, applied to an artery following angioplasty, to prevent a new buildup of plaque.

Pro
About 90 percent get relief from their chest pains.
Con
About one-third need it again within six months to reopen the same artery.
Thrombolysis
Restores bloodflow by dissolving blood clots that have formed in an artery clogged by plaque. During thrombolysis, a doctor threads a catheter to the clot, then releases a clot-dissolving drug directly into the blockage.

Pro
Delivers the drug straight to the clot, without affecting surrounding tissues.
Once the clot dissolves, plaque deposits are easier to find and remove.
Con
Can cause excessive bleeding.
May require overnight hospital stay.
Bypass surgery
This is an option when medications and angioplasty don’t work. A surgeon removes a blood vessel from the leg or chest and uses it to bypass-carry blood around-a section of blocked artery.

Pro
Works well to restore blood flow.
Con
Some studies show that bypass surgery doesn’t always provide better results than medications, lifestyle changes, or angioplasty.