Harvard Heart Letter

Heart Beat: Peripheral artery disease and stroke

The heart isn't the only part of the body prone to developing clogged arteries. They appear almost everywhere, including the legs. Plaque-clogged leg arteries often go unnoticed, and doctors tend to overlook them. But this condition, called peripheral artery disease (PAD), is a heart attack waiting to happen.

PAD may be particularly problematic in stroke survivors or people who have had a transient ischemic attack (TIA, or ministroke). In a study of 102 such individuals, one-quarter had undiscovered PAD. Among those with the condition, 52% had a heart attack or repeat stroke over a two-year period, compared with just 16% of those without the condition (Stroke, published online Aug. 29, 2009).

Testing for PAD is simple. It involves using a blood-pressure cuff and an ultrasound probe to measure blood pressure in two arteries that supply the foot. The highest pressure recorded at the ankle is divided by the highest pressure recorded at the arm. This gives the ankle-brachial index. An index under 0.90 means that blood is having a hard time getting to the legs and feet; one over 1.30 is a sign of stiff, calcium-encrusted arteries.

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