Doctor Hopes Arterial Disease's Dangerfield Quality Will Diminish

MINNEAPOLIS, Minn. -- Dr. Alan Hirsch, of Abbott Northwestern Hospital, calls it the Rodney Dangerfield of diseases.

Unlike heart attacks and strokes, he said, peripheral arterial disease, or PAD, gets no respect. Now, he hopes, that will change.

For the first time, national guidelines were issued Tuesday to help doctors and others identify the condition, which affects about 12 million Americans.

Hirsch, who helped write the guidelines, said many people don't realize they have the disease, which can be as deadly or disabling as a heart attack.

Sometimes, the only symptom is leg pain while walking, which people often shrug off as normal aging.

Yet untreated, PAD can lead to high blood pressure, kidney failure, aneurysms and other dangerous complications.

PAD is caused by blockages in the arteries that supply blood to the legs and organs other than the heart.

The problem, Hirsch said, is that doctors rarely look for it during routine exams. "We're saying to physicians for the first time, 'Don't wait for the patient to complain to you about symptoms that they may not appreciate as hallmark signs of poor health,"' he said.

Charlotte Kresal of Onamia, Minn., said she had leg pain for at least 15 years before she learned the cause, after her fourth heart attack.

"It got real bad while I was walking, and it would keep me awake at night," said Kresal, 67. "I'd mentioned it to several doctors," she said, but "never pursued doing anything about it."

But last year, doctors found blockages in her legs and referred her to Hirsch for treatment. Since the blockages were removed, she can move about without pain.

Her advice to others: "If you have repeated severe leg pain, see a doctor about it and pursue it. If that doctor doesn't want to, see another doctor."

The new guidelines urge doctors to ask patients older than 50 whether they have a history of walking impairment or whether a relative has had an aneurysm -- a bulge in an arterial wall. Also recommended are such simple tests as pulse rates and blood pressure checks around the ankles, which may signal a problem.

"It's kind of obvious stuff, but no one is doing it," said Hirsch, a professor at the University of Minnesota Medical School.

Hirsch, who has been a national leader in raising public awareness of PAD, chaired the committee that wrote the national guidelines. They were released by the American Heart Association and American College of Cardiology.