Peripheral arterial disease, also called peripheral artery disease (PAD) is a disease that affects the blood vessels in the limbs. Roughly 6.5 million people age 40 and older in the U.S. have PAD. This number is expected to increase due to the number of people with diabetes, which is a major risk factor for PAD.

PAD develops from a buildup of fatty deposits in the blood vessels (called atherosclerosis). Atherosclerosis narrows the blood vessels and leads to a decrease in blood flow and oxygen to the muscles. People with PAD often experience leg pain in their calves when they walk —or participate in any type of physical activity—because the low blood flow is unable to keep up with the increased demand of the working muscle. Essentially the muscle is “starving” for oxygen and the end result is pain. However, the leg or calf pain usually goes away within 10 minutes of rest as the blood flow and resting muscle “catch up” to the demand.

This cycle of exertional leg pain with relief upon rest is called intermittent claudication. Intermittent claudication affects about 10% of people with PAD. In severe cases, some people have pain in the limbs even at rest (called critical limb ischemia). People with PAD have higher rates of cardiovascular events such as heart attack, as well as trouble walking, increased loss of mobility, limb amputation and an overall poorer quality of life.

Smoking and diabetes are two of the greatest risk factors for the development of PAD. In fact, quitting smoking is one of the first recommendations to treat and better manage PAD. Other standard cardiovascular risk factors, such as high cholesterol and high blood pressure, are also associated with an increased risk of developing PAD.

In addition to quitting smoking, supervised exercise (exactly what it sounds like—exercise supervised by a medical care team member) is a commonly used therapy for PAD. Unfortunately, many people choose not to participate in supervised exercise. Alternatively, home-based exercise programs that are designed to help people with PAD to develop healthier lifestyle habits can be highly effective.

Medications such as statins (which lower cholesterol) and antiplatelet therapy (which work to prevent blood clots) can help reduce symptoms and slow disease progression.

Revascularization (changing the route of the blood flow surgically) can improve the blood flow in a small number of cases, but it doesn’t treat the underlying atherosclerosis of the affected vessel. Surgery is often a last resort for disease management in people with PAD.

Aging, another risk factor for PAD, is unavoidable. However, to help reduce your risk of developing PAD, you can make lifestyle changes to stop smoking, control your diabetes with diet changes, and find enjoyable ways to be physically active.