00:01
Let's talk a little bit about therapy. Well,
therapy: What's the goal? The goal is
• To relieve the pain of intermittent claudication
• To improve exercise tolerance by increasing
the distance that people can walk before they
get claudication
• And, of course, preventing critical artery
occlusion that can lead to ulcers; to gangrene,
which is necrosis (death of tissue); and eventually
even amputation of the… part of the leg
or even above the knee if the disease is very,
very severe.
So there are a number of treatments. First
of all, our lifestyle measures: All of these
attempt to reverse the atherosclerotic process.
00:45
• Smoking cessation
• Lipid-lowering therapy: There's a number
of excellent drugs—the statin drugs being
the best ones—that induce stabilization
of atherosclerotic plaques. And if you get
the cholesterol low enough, you may actually
pull some of the cholesterol out of the atherosclerotic
plaque.
01:01
• Control of diabetes and hypertension
All of these improve the situation for peripheral
vascular disease. Regular supervised exercise
is very important. Again, we mentioned already
one medication: the cholesterol-lowering medication
(the statins). But there are also mild blood
thinners that prevent blood clots from forming
in these arteries. If the narrowing is so
severe and the symptoms are so severe, angioplasty
with the balloon and stents or surgery can
open up the artery and make the patient feel
much better with resolution of those symptoms.
01:39
Hopefully, what we do is we are able to do
this before we get to angioplasty and surgery:
rather, the lifestyle changes and the medicines,
hopefully, stabilize the situation so angioplasty
and surgery are not necessary.
Walking and exercise is a very important part
of this therapy. It's been 40 years since
people first noted that regular walking, usually
almost every day, 30 minutes (at least three
times a week, but preferably almost every
day) can markedly improve symptoms by encouraging
the formation of new collateral blood vessels
and particularly by improving muscle efficiency
so the muscles don't require as much blood
flow. Many patients experience a dramatic
increase in the distance they're able to walk
without pain when they follow a regular walking
exercise program. And there are also vascular
rehabilitation programs (just like there are
cardiac rehabilitation programs) that emphasize
lifestyle change, taking your medication,
and certainly exercise.
02:45
How can you prevent getting to this point?
Of course, it's the same thing: It's lifestyle
changes and control of all the things that
lead to atherosclerosis. So:
• Not smoking
• Control of blood pressure
• Regular physical activity
• Weight control
• Diabetes control
And in the medication areas:
• Antiplatelet or anticoagulant agents:
thinning of the blood to prevent the blood
clot
• ACE inhibitors: one of the very best forms
of blood pressure control (we'll talk more
about them in later lectures on hypertension)
• Beta blockers also are very helpful, particularly
where heart function is decreased.
03:25
• Lipid management: as I mentioned, the
statin drugs to get the cholesterol down
• And avoidance of hormone replacement therapy,
since that can exacerbate the atherosclerotic
process in women
So these are the whole spectrum of prevention
guidelines, and we'll be talking about more
of these individually for different conditions
as we go along.