The simple answer is that all people are affected by the disease and everyone is at risk of developing symptoms, however, some are much more than others. Even those with the lowest risk are more likely to die from cardiovascular causes, but they will get the disease later in life.

4. What is the cause of atherosclerosis?

There isn’t any single cause for arterial disease. It is more likely to be caused by a combination of factors, amongst which the wear and tear effect, the genetic [inherited, familial] predisposition and the high concentration of low density lipoproteins in the blood, reflecting the high intake of saturated fat in the diet are the most prominent.

.  Combination of risk factors. These combinations cause the most problems. Most vascular diseases are caused by such combinations, because the arteries stand reasonably well to one risk factor in isolation. The risk of heart attack is trebled if the patient smokes, has a serum cholesterol of 6mmol/l and has a diastolic blood pressure greater than 85mmHg.

There isn’t much you can do to avoid the disease; however, there is much you can do to slow it down.

.   Stop smoking

.   Have regular exercise

.   Change your diet. Eat whatever flies [poultry, etc.], swims [fish], drops [fruit] or grows [wheat, vegetables]. Avoid animal fat. Red wine is also helpful. It is better to have more frequent and small rather than a single large meal.

.   Lower your cholesterol. Walking and regular exercise is the best means to reduce the cholesterol and increase the beneficial cholesterol called HDL. If your blood cholesterol level is high and cannot be brought to normal by strict diet, your doctor may prescribe some specific drugs [simvastatin, pravastatin, etc.].

.   Look after your blood pressure.

.   Take a small dose of aspirin [75-150mg] daily. Affects the platelets, an essential factor in atherosclerosis, reducing the overall risk by 25%.

.   Take good care of your feet; avoid injuries and infection.

.   Consult your doctor early if you develop symptoms.

The functional effect of the blockages can be easily checked by measuring the blood pressure at your ankle [a quick and painless test done by your specialist].

There are several things you can do which may help. The most important is to stop smoking, take regular exercise and lose weight.

.  Smoking. If you are a smoker you must make a sincere and determined effort to give up completely. Firstly, it speeds up hardening of the arteries [atherosclerosis] which is the basic cause of trouble and secondly, cigarette smoke causes spasm of the small collateral vessels, reducing thus further the amount of blood and oxygen delivered to the muscles.

The best way to give up is to choose a day when you are going to stop completely  rather than trying to cut down gradually. If you do have trouble giving up please ask your doctor who can give you advice on nicotine gum and patches or put you in touch with a support group. Unfortunately, although many patients cut smoking down, only 30% give it up completely.

.   Diet. It is very important not to put on weight, because the more weight the legs have to carry around  the more blood they will need. Your doctor or dietitian will give you advice with regard to weight reducing diet. If your blood cholesterol is high you will need a low fat diet and may also require cholesterol lowering drugs.

.  Exercise. There is good evidence that people who take regular exercise [walking at a regular pace until pain comes on, then stopping and continue again when the pain disappears] develop a better collateral circulation. Try to make it a little further each day and you will almost certainly find that the distance you can manage without pain slowly but steadily increases. Regular exercise for at least 6 months has been shown to improve the claudication distance [distance you are able to walk without pain] by 180% and the maximum walking distance by 120%.

.   Blood pressure. If you have a high blood pressure it is important that this is well controlled by tablets. You should have regular checks by your GP.

5. What about treatment?

·         Most people with intermittent claudication do not require surgery.

The conservative treatment [summarised in the previous table] suffices in the majority of the cases.

·         However if your symptoms are severe [claudication distance less than 100m] and make your life difficult, or if they do not improve with the conservative treatment, further treatment may be necessary.

·         An x-ray of the arteries [arteriogram] is usually performed first to see what can be done. Short blockages can be stretched open with a balloon [angioplasty] in the x-ray department. This is usually done under local anaesthesia and often involves an overnight stay in the hospital.

·         Longer blockages can be bypassed using either a plastic tube or a vein from your leg [bypass graft]. This is a major operation under general anaesthesia and involves being in the hospital for about a week to ten days.

The decision about surgery is usually one for you to make yourself after your specialist Vascular Surgeon has explained the likelihood of success and the risks involved. There is an overall risk of 1% of surgery threatening your limb after failure, plus the risk of surgery and anaesthesia. However, on average, these grafts remain open in 70% of patients for 5-10 years. Angioplasty has a lower overall risk, however the long term result is not as good as surgery. Only 50% of balloon stretched arteries are open after 12 months and the blockage rate is 10-15% per year afterwards. More detailed information about these procedures is also available - please ask your specialist.

·         The exact place of surgery and angioplasty in people with less severe claudication is unclear at present. The risk of surgery and / or angioplasty should be balanced against your overall benefit. However, there is evidence that early intervention is beneficial as the policy to intervene only on patients with severe short distance claudication has a number of potential drawbacks:

3)  The patients quality of life is reduced

Although there are quite a number of proprietary tablets and drugs on the market [vasodilators, haemorrheological agents etc.] there is very little evidence that they will actually help - drugs will not unblock the artery. Perhaps your doctor has already tried one of these drugs in your case, so that you can judge for yourself.

·    Aspirin is the only drug that has a beneficial effect and is usually prescribed in small doses [75-150mg per day]. It makes the blood less sticky and lowers the risk of heart attack and strokes.

·    A variety of similar drugs can be used, especially if aspirin causes side-effects.

·    Drugs to reduce your cholesterol may be necessary if all the other measures to control it fail.

The most important thing is that you improve your lifestyle - keep walking, lose weight and stop smoking!

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Please note:
A written referral from a general practitioner is helpful but is not essentially required in order to make an appointment to see a consultant specialist.