Feb 22, 2012 7:10 PM
Feb. 22, 2012 -- Low-dose aspirin may be just as effective as the more expensive Plavix when combined with a walking program to treat leg pain that's associated with narrowing of the leg arteries.
What's known as peripheral artery disease, or PAD, can cause pain in the legs during walking because of decreased blood supply in the legs. This is known as intermittent claudication. This pain usually goes away once a person stops walking.
People with PAD are also at higher risk for heart attack or stroke. Treatment involves reducing pain and improving heart and blood vessel health by addressing risk factors such as high blood pressure and high cholesterol.
In the three-month study, people with PAD participated in a one-hour-a-day walking program. The goal of a walking program for PAD is to allow people to walk longer without pain. Some participants took low-dose aspirin and others took Plavix, an anti-clotting medication.
After 12 weeks, those who took aspirin could walk pain free about a third farther and longer before it hurt too much and they had to stop, compared to before starting the program. There were similar gains seen among people who took Plavix.
The new study shows that the two agents are similar when it comes to pain-free walking. Low-dose aspirin is also much less expensive than Plavix. This may change when Plavix becomes available as a generic drug.
The new findings appear in the Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease.
Tara Narula, MD, says low-dose aspirin is her "go-to" drug for people with PAD. She is the director of clinical cardiology at Lenox Hill Hospital in New York City. "I am going to put them on aspirin because I am more concerned about their higher risk of stroke and heart attack," she says.
Low-dose aspirin can help reduce these risks. She also stresses the importance of tight control of heart disease risk factors with her PAD patients. These include high blood pressure and high cholesterol.
The real problem with PAD is that many people are still not aware of its signs and symptoms. "It is under-recognized by patients and physicians. They don't pay attention to the leg pain or think it is muscular or neurological and they blow it off," Narula tells WebMD.
If you have pain when you walk in back of one or both of your legs that gets better with rest, then getting checked for PAD may be in order.
Verghese Mathew, MD, agrees. He is an interventional cardiologist at Mayo Clinic in Rochester, Minn. The big picture with PAD is all about improving overall heart health. This includes controlling blood pressure, cholesterol levels, diabetes, and encouraging people to quit smoking if they smoke.
"Intermittent claudication is a symptom, but PAD is a powerful [indicator] of risk for heart disease," he says.
Mathew says treatment of PAD can sometimes come down to a case-by-case basis. For some people with PAD, Plavix may be better at reducing risks for heart attack and strokes, even though it appears to be similar to aspirin in terms of pain-free walking. "Heart risks should be managed aggressively in people with PAD," he says.
Juan P. Zambrano, MD, suggests aspirin for people with PAD unless they are allergic to it or can't take it long-term due to stomach irritation. He is the director of the vascular section of interventional cardiology at the University of Miami Miller School of Medicine.
Sometimes he needs to bring in the big guns like Plavix, but he usually reserves this for people who are having surgery to open blocked leg arteries.
Importantly, Zambrano says, the study shows the benefits of exercise. "This is one more study that shows you when PAD patients exercise they can walk more and tolerate more distance."