Frequently Asked Questions

Q. When young persons in their 20's or 30's get PAD, is it because of an unusual hereditary problem with the structure of their arteries at birth, or a speeding up of the aging process?
A. First, one has to be sure that the young person has an accurate diagnosis of PAD. If so, PAD can occur even at an early age in the presence of the same risk factors that cause PAD in older individuals: smoking, diabetes, high cholesterol, high blood homocysteine, and a family history of PAD or coronary heart disease. While it is quite unusual to develop symptoms of PAD before age 40, we know that artery damage starts at young ages (we find evidence of artery damage even in young healthy soldiers who are killed in war). However, not all artery blockages in young individuals are due to PAD, but may be due to other conditions that can block the arteries to the legs (such as "fibromuscu lar dysplasia" or certain leg artery cysts). Other medical conditions can also lead to artery blockages at younger ages, including severe kidney disease, transplantation, or trauma.

Q. My husband was diagnosed with hardening of the arteries. He is 52 and has had numerous health problems, atrial fibrillation at 40, a stroke at 45 and since then many TIA's. He is a heavy smoker and we do know that he definitely needs to quit in order to slow this progression. Since he has been on Coumadin® and medications for these conditions for many years, why would this happen?
A. It is never possible to know for certain why some individuals, like your husband, would have so many health problems in their 40's or 50's. As you are likely aware, stroke can occur from either atrial fibrillation alone or from damaged carotid arteries that lead to the brain, or both. In order to best decrease his risk of stroke, the Coumadin prevents blood clots from the atrial fibrillation from traveling to the brain. The other medications prevent artery damage and thus decrease both heart attack and stroke risk. But, while these medications are effective in decreasing "risk", and are essential, they are not curative. The impact of continued smoking is profound, and can diminish the benefit of Coumadin (tobacco use makes the blood clot more easily); of blood pressure pills (tobacco use raises blood pressure); and of cholesterol lowering drugs (tobacco directly damages the artery wall). He needs to stop smoking. Until then, taking medications regularly and as pre-scribed likely has helped your husband more than not being on them, by providing him at least some protection.

Coumadin® is a registered trademark of Bristol-Myers Squibb Company