factors include diabetes or prediabetes, a history of heart attack or stroke, and ethnicity: African-Americans are twice as likely to develop PAD. In fact, their risk is on par with pack-a-day smokers, according to the Society of Interventional Radiology.

Evidence abounds as to the diagnostic effectiveness of this simple procedure. Additionally, you may want to request both a “resting” ABI as well as a reading after exercise. A 2006 study published in the Archives of Internal Medicine found that combining pre- and postexercise measurements enhances the sensitivity of the ABI and helps identify PAD in patients who would have otherwise been missed.

Just why isn’t such a simple test given more frequently? “The awareness level of PAD just isn’t where we’d like to see it yet,” says Goodman. Both Goodman and Jaeggli stress the need for education. Getting healthcare providers to ask the right questions of their patients and schooling patients not only to speak up about any symptoms they may be experiencing, but also to request an ABI test if they know they have any combination of risk factors.

The importance of an early diagnosis, or better yet prevention, can’t be underestimated. If there is good to come from PAD, says Goodman, it’s that the diagnosis provides a lifesaving warning signal to check for other vascular and coronary heart diseases that often lead to heart attack and stroke. “PAD provides a window to the entire cardiovascular system,” Goodman stresses. “If you have a low ABI, it’s likely your carotid artery [a key artery located in the front of the neck that’s responsible for blood flow from the heart to the brain] is blocked to some degree, as well as arteries in your heart, not just the legs,” he says. “The ABI is a very sensitive marker for blocked arteries anywhere in the body.”

What you can do
Not surprisingly, strategies to prevent PAD are similar to those used to control the disorder once it’s diagnosed. (See “Take Control” on page 51.) Heart- and vascular-healthy practices such as regular exercise, quitting smoking, maintaining a healthy weight, and eating a nutritious diet are all important steps recommended by healthcare practitioners to help prevent PAD, as well as all other types of cardiovascular disease.

In addition, Jaeggli often recommends an individualized combination of the following supplements: magnesium sulfate, L-arginine, niacin in the form of inositol hexaniacinate, a basic vitamin B complex, along with additional B6, B12, and folic acid; an omega-3 supplement high in essential fatty acids EPA and DHA, coenzyme Q10 (Co-Q10), and vitamin E (natural d-alpha form) with mixed tocopherols.

“The benefits of all of the above recommendations are study-backed,” says Jaeggli. “However, one of the most important and well-studied PAD-specific supplements is L-arginine,” she adds. “An amino acid that acts as a free-radical scavenger and has an immediate vasodilating effect to the blood vessels, L-arginine also has the positive long-term effect of helping to inhibit plaque formation.”

Although supplements are extremely safe, “you should always work with your healthcare practitioner to design an individualized therapy program, and the goal should be the minimum dose needed to achieve the desired effect,” Jaeggli cautions. If supplementing with this common amino acid, you may want to ask for a sustained-release preparation. A 2005 study found that sustained-release L-arginine achieved positive therapeutic results with lower