What Vitamins to Take for Peripheral Artery Disease?

Introduction

Peripheral arterial disease (PAD), or peripheral vascular disease (PVD), is the name for a disease caused by the build-up of fatty deposits in the arteries that restricts blood supply to the legs and the leg muscles.1 It is often, but not always, caused by poor lifestyle choices and diabetes.

Various vitamins are suggested to reduce your risk of developing the disease and supplement your health.

Reading this article, you will learn:

  • What peripheral arterial disease is, and how it is managed
  • Can vitamins prevent peripheral arterial disease?
  • Current clinical trials in progress
  • Lifestyle changes to combat PAD

What is Peripheral Artery Disease (PAD)?

Peripheral artery disease (PAD) is an umbrella term for common circulatory conditions usually caused by atherosclerosis, which is a build-up of fatty deposits called atheroma in the blood vessels. 

Atheroma is composed mainly of cholesterol and other waste substances produced by the body. When these ‘clog’ the arteries, it prevents blood flow to the legs, and this causes symptoms and discomfort.1 

Currently, there are estimated to be approximately 8.5 million people suffering from PAD in the USA, with over 200 million further sufferers of PAD worldwide.2 

Causes and Risks

The build-up of atheroma on the walls of the blood vessels causes the vessels to become narrower, meaning less blood can flow through them to supply the legs with blood and oxygen. This is called atherosclerosis and is the most common cause of PAD.1, 2 

The most common risk factors that increase your chance of developing PAD include:

  • Smoking - Single-handedly the largest risk factor 1
  • High blood pressure
  • High cholesterol
  • Type 1 and Type 2 diabetes - Type 2 being the greater risk factor

PAD is often associated with other conditions. If you suffer from PAD, it is increasingly likely that you may also suffer from another disease. This is called a comorbid disease or comorbidity. Examples of these comorbid conditions include:

  • Coronary heart disease
  • Cerebrovascular disease

Signs and Symptoms

Many patients with PAD may be asymptomatic. However, people assigned male at birth are more likely to present the most common symptom of PAD than people assigned female at birth, which is claudication.2 Claudication is a pain in the legs caused by a lack of blood flow supplying the muscles, reducing blood and oxygen delivery. 

Some of the usual symptoms patients experience include:

  • Claudication 2
  • Numbness of the legs 
  • Generalised leg discomfort
  • Hair loss on legs or toes 1
  • Ulceration or gangrene of toes 2
  • Erectile dysfunction in people assigned male at birth

Common signs of PAD that are picked up by your health practitioner include:

  • Diminished pulses in the leg
  • Pallor (paleness) when the leg is elevated
  • Arterial bruits - audible vascular sounds heard with a stethoscope

Several markers can indicate PAD that may be picked up by your GP during blood test investigations. These are inflammation markers, thrombosis markers, and elevated lipoprotein levels.2 

Diagnosis

Once you and your GP have recognised that you have symptoms of PAD, you can be tested for the condition. A common technique is called noninvasive arterial testing of the legs. In this test, the blood pressure is measured at several points along the length of the leg to assess blood pressure changes and compare them to blood pressure measured from the arms.2

Other than this method, your doctor may ask you to take part in exercise testing. This is usually on a treadmill, used to measure pain-free walking times and distances, and can be used to assist detection of mild PAD.

Treatment

Treatment is very important for PAD to reduce the risk of adverse cardiovascular disease events and preserve the functioning of your legs, all whilst reducing symptoms. However, there is no cure for PAD. Treatments and lifestyle changes can only reduce symptoms.3 

To help treat the condition, your GP may offer you a plan for a healthier lifestyle.3 This could consist of asking you to:

  • Stop smoking
  • Eat a balanced diet
  • Exercise regularly. This can be as simple as just taking a walk every day.
  • Cut down on alcohol consumption

In terms of medications that may be prescribed, these are used to treat the underlying cause of PAD.3 Most commonly, these are: 

  • High cholesterol 
  • High blood pressure
  • Diabetes

Prescribed medications for PAD include:

  • Statins. For patients with high cholesterol.
    Statins are used to reduce the levels of ‘bad’ cholesterol, called low-density lipoprotein (LDL) cholesterol, which causes atherosclerosis.
  • Antihypertensives. For patients with high blood pressure.
    Antihypertensives reduce your blood pressure. A common example is angiotensin-converting enzyme (ACE) inhibitors.
  • Blood thinners. These medications prevent the formation of blood clots, often caused by atherosclerosis. 
    Blood thinners thin your blood, so it is less likely to clot. A common example of a drug used for PAD is aspirin at low dosages.1
  • Insulin therapy. For people with diabetes.
  • Naftidrofuryl sulphate. Prescribed if you have claudication caused by exercising.3

Foods that Mitigate PAD Risk

One of the major treatments of PAD is through lifestyle changes and, most importantly, by adopting a healthy diet. The question is, why does a healthy diet improve symptoms?

Foods contain many vitamins and fatty acids, some of which have been proven to help reduce symptoms, the risks of developing PAD, and associated cardiovascular diseases/circulatory conditions. 

Omega 3 Fatty Acids

This is a healthy fat that does not raise blood cholesterol levels. They can help lower LDL cholesterol levels to reduce symptoms and prevent atherosclerosis.4

Omega 3 fatty acids can be found in:

  • Fatty fish: salmon, sardines and herring
  • Vegetable oils: olive and canola oil
  • Nuts and seeds

Berberine

This is an alkaloid found in plants such as Oregon grape and European barberry and can relax vascular smooth muscles in blood vessels to increase blood flow and increase blood delivery to the legs.5 Berberine can also lower LDL cholesterol levels to minimise atherosclerosis.6

However, as large doses are required for Berberine to be effective, this alkaloid may not be effective as a PAD preventative.5

Flavonols

These compounds can naturally lower your blood pressure to prevent blood clots and improve blood flow to your peripheral arteries, improving symptoms. They can act similar to blood thinners.6 Flavanols are found in: 

  • Tea
  • Blueberries
  • Apples
  • Peanuts

Flavanols can also be found in dark chocolate!7

Vitamins

Vitamin K

Studies suggest that vitamin K1 and K2 can reduce your risk of PAD, especially if you already suffer from high blood pressure or diabetes. It is thought that this occurs through a vitamin K-induced decrease in cardiovascular calcification.8 

Vitamin K is mainly found in plant-sourced foods.8 Specifically:

  • Green, leafy vegetables
  • Vegetable oils

Niacin (Vitamin B3)

Vitamin B3 is essential for general good health, and it is advisable to take supplements as part of a healthy lifestyle. Supplements can lower your bad cholesterol and increase high-density lipoprotein (HDL) levels for cholesterol clearance and healthy arteries.6 

However, studies suggest no improvement in artery function, blood clotting or reduction of cardiovascular symptoms with niacin supplementation.9

Folate

Folate may help prevent PAD development, but more research in this area is required to find definitive answers. Some research does not support folic acid supplementation.6, 10

Vitamin C

Vitamin C is suggested to have benefits for PAD, as many patients with PAD are often vitamin C deficient. Vitamin C depletion can also be attributed to inflammation in people living with PAD. However, there is no sufficient evidence to support vitamin C as a potential treatment as of yet.11

Vitamin D

Vitamin D is also slightly deficient in people with PAD, and some people take supplements for this reason. Increasing vitamin D through supplementation could cause an increased risk of calcium deposition in the blood vessels, which could cause further damage, so it may not be advisable to take.11

Vitamin E

Vitamin E is also sometimes deficient in PAD patients. However, vitamin E supplementation has not shown consistent results in reducing PAD symptoms or disease progression.11 

Take care as this vitamin can interfere with blood-thinning medication, thus increasing the risk of bleeding.11 

Other Supplements: Cholesterol-Lowering Stanols and Sterols

Stanols and sterols have a structure similar to cholesterol and can reduce the absorption of cholesterol in the gut, so more cholesterol is excreted through faeces. 

They are often added to fat-based spreads or yoghurts; eating these products can help you reach the number of stanols and sterols to lower your cholesterol levels considerably to prevent atherosclerosis or manage the symptoms.12 

Lifestyle changes and PAD

Other than increasing vitamins, healthy fats and flavanols, there are more ways to improve your diet to reduce the risks or symptoms of PAD. These include:

  • Limiting saturated and trans fat foods in your diet. These can increase your ‘bad’ cholesterol levels and cause atherosclerosis.
  • Reduce your salt and sodium intake. High sodium can cause water retention and increase blood pressure, leading to cardiovascular complications. Reducing sodium intake decreases blood pressure levels and is also associated with a reduction in cardiovascular-related deaths.12
  • Increase your fibre intake. A high fibre diet can reduce the risks of developing PAD and improve symptoms. To increase fibre, replace white bread and grains with wholewheat alternatives and choose higher-fibre breakfast cereals such as shredded wheat or porridge.

Clinical Trials

Clinical trials using vitamins for PAD are limited, given that they may not be effective.

A clinical trial from 2009 used folate for the treatment of PAD.  A modest improvement was seen in peripheral arterial blood circulation compared to placebo groups. However, there was no reduction in inflammation, which is essential in decreasing symptoms of atherosclerosis. The outcomes of the patients were also varied.10 

Therefore, further research is necessary to determine if vitamins have any clinical function in PAD treatment.

Summary

Overall, PAD is a disease commonly caused by atherosclerosis, produced by adopting poor lifestyle choices or suffering from underlying disorders. 

However, it can be managed successfully through several lifestyle factors and medications to allow patients to live a long and healthy life. 

Most vitamins do not have enough research to prove clinical effectiveness for PAD, so patients should not rely on them for results.

Please remember to:

  • Check with your GP or pharmacist before taking any new vitamins, as these could interfere with the medications you are already taking. If you have kidney disease, you may not be able to take vitamin supplementations at all.
  • Always adhere to instructions on the label of the vitamins. 
  • Before taking any medications or vitamins, try to adjust your lifestyle first - you may not need further treatments.

References

  1. NHS. Overview, Peripheral arterial disease (PAD) [online]; 2019. Available from: https://www.nhs.uk/conditions/peripheral-arterial-disease-pad/ [accessed 21 Mar 2022]
  2. Kullo IJ, Rooke TW. Peripheral Artery Disease. The New England Journal of Medicine; 2016; 374(9): 861-871. 
  3. NHS. Treatment. Peripheral arterial disease (PAD) [online]; 2019. Available from: https://www.nhs.uk/conditions/peripheral-arterial-disease-pad/treatment/ [accessed 21 Mar 2022]
  4. St. Joseph’s Healthcare Hamilton. Healthy eating for Peripheral Arterial Disease (PAD) [online]; 2011. Available from: https://www.stjoes.ca/patients-visitors/patient-education/p-t/PADHealthyEating-trh.pdf 
  5. Bagade A. Cardiovascular Effects of Berberine: A Review of the Literature. Journal of Restorative Medicine; 2017; 6:37-45.
  6. WebMD. Supplements for PAD [online]; 2021. Available from: https://www.webmd.com/heart-disease/supplements-for-pad [accessed 21 Mar 2022]
  7. Harvard Health. Cocoa: a sweet treat for the brain? [online]; 2015. Available from: https://www.health.harvard.edu/blog/cocoa-sweet-treat-brain-201502057676#:~:text=Flavanols%20in%20cocoa%20have%20been,clots%2C%20and%20fight%20cell%20damage. [accessed 21 Mar 2022]
  8. Vissers LET, Dalmeijer GW, Boer JMA, Monique Verschuren WM, Schouw YT, Beulens JWJ. The relationship between vitamin K and peripheral arterial disease. Atherosclerosis; 2016; 252: 15-20. 
  9. Stricker H, Bianda T, Guidicelli-Nicolosi S, Limoni C, Colucci G. Effect of a SIngle, Oral, High-dose Vitamin D Supplementation on Endothelial Function in Patients with Peripheral Arterial Disease: A Randomised Controlled Pilot Study. European Journal of Vascular and Endovascular Surgery; 2012; 44(3): 307-312. 
  10. Khandanpour N, Armon MP, Jennings B, Finglas M, Willis G, Clark A, Meyer FJ. Randomized Clinical trial of folate supplementation in patients with peripheral arterial disease. British Journal of Surgery; 2009, 96(9): 990-998. 
  11. Health essentials. The Truth About 5 Common Dietary Supplements for Vascular Health [online]; 2016. Available from: https://health.clevelandclinic.org/the-truth-about-5-common-dietary-supplements-for-heart-health/#:~:text=Vitamin%20C%20has%20been%20shown,in%20those%20taking%20increased%20doses. [accessed 24 Mar 2022]
  12. Grillo A, Salvi L, Coruzzi P, Salvi P, Parati G. Sodium Intake and Hypertension. Nutrients; 2019; 11(9):1970.

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Laura Preece

BSc Pharmaceutical Sciences and MRes Pharmacy and Pharmaceutical Sciences
I am a researcher and medical writer with a passion for pharmaceutics, disease and biological sciences. I am currently researching cellular and molecular biology, investigating the use of vitamin C as an adjunctive therapy for diabetes mellitus.

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