Peripheral artery disease (PAD) is the second most common form of cardiovascular disease (CVD) after coronary artery disease. Arteries in the lower limbs or supplying major organs become narrowed as a result of deposits of cholesterol. Blood supply to the limbs is reduced, leading to cramping or pain in the leg and hip muscles during activity, especially walking. As peripheral artery disease progresses, pain may become more persistent. In its most advanced form, PAD can lead to tissue damage and gangrene in the limbs, possibly requiring amputation. Numbness in the limbs, sores on the legs or feet, pale or blue skin on the legs or hair loss on the legs and feet are possible symptoms of PAD. The condition is more common in men and may progress for a long time without symptoms. PAD can be diagnosed by comparing the blood pressure at the ankle and the arm; lower blood pressure at the ankle, caused by a restricted blood supply, indicates PAD.
People who develop PAD are at high risk for a stroke or heart attack. PAD is already present in around one in twenty people in the 45-50 age group and the risk increases with age and in people with other risk factors for cardiovascular disease, especially smoking or diabetes. Stopping smoking and taking regular exercise can improve the condition, as can reduction of cholesterol, blood sugar and blood pressure through lifestyle and dietary changes and medication.
A large study presented at last month’s IAS Conference on HIV Science (IAS 2017) showed that people living with HIV with CD4 counts below 500 were at higher risk of developing PAD than people without HIV of the same age and ethnic group, after taking into account smoking, lipid levels and other risk factors for cardiovascular disease. The risk was approximately 24% higher for people with CD4 counts between 500 and 200 and 73% higher for people with CD4 counts below 200. The findings underline the importance of starting HIV treatment as soon as possible after diagnosis, especially in older people, as well as the protective effect of a high CD4 cell count.
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