'Cosby' star focuses on little-known disease

By Jaweed Kaleem

McClatchy Newspapers

MIAMI --  Phylicia Rashad's father died more than 20 years ago of a heart attack, but she has recently wondered if that needed to be the case.

"His death certificate read 'cardiac arrest due to hypertension due to diabetes,'" said Rashad, famous for her role as Claire Huxtable on "The Cosby Show."

Yet what Rashad never considered is that he may have had Peripheral Artery Disease, a relatively unknown blood vessel condition that affects 8 million Americans, or about 1 in 40 adults. Miami ranks No. 18 on the list of U.S. cities with the highest rates of the disease, according to the Peripheral Arterial Disease Coalition. Fort Lauderdale is No. 11, while Detroit comes in at No. 1.

Rashad, a longtime advocate for diabetes organizations, has been touring the nation on a media campaign about the disease _ shortened to P.A.D. _ that causes poor circulation in the legs because of fatty deposit (plaque) buildup in the lower arteries.

"That means there is poor circulation in the arteries leading to the heart and the brain," said Rashad, 60, who stopped by Miami Beach last week. "It doubles the risk of having a heart attack or stroke and quadruples the risk of dying from heart disease." It can also lead to gangrene and require amputation, a fate Rashad's aunt suffered.

In addition to her father, seven of Rashad's family members have died of a heart attack or stroke, and each lived with P.A.D. risk factors. In people over 50, those include diabetes, high blood pressure, high cholesterol and smoking tobacco. They also include less-specific potential symptoms such as pain in the legs, thighs, buttocks and cramping when walking or exercising.

"It could be confused with old age, arthritis or increased weight," said Dr. Manuel Mayor, a cardiologist at Jackson Memorial Hospital. "But you need to consider P.A.D. as a possibility."

The condition can be an early warning sign of bigger problems to come, Mayor said, adding that one reason South Florida ranks high in P.A.D. rates may be its population of blacks, Hispanics and the elderly, all risk groups. According to the American Diabetes Association, 10.4 percent of Hispanic adults and 11.8 percent of non-Hispanic black adults have diabetes, nearly twice that of the 6.6 percent for non-Hispanic whites. In addition, hypertension is more prevalent among blacks and Hispanics than non-Hispanic whites.

Because P.A.D. _ first identified a decade ago _ is not something most doctors check for during physical examinations, many people don't know about it. In the September 2007 issue of the medical journal Circulation, three-quarters of Americans polled could not identify P.A.D. The test, which must be requested, measures the Ankle Brachial Pressure Index, or the ratio of the blood pressure in the arms to the ankle.

"If you have P.A.D., the blood pressure in your leg is lower than in your arm," Mayor said. "Sixty percent of P.A.D. patients...are going to have some disease of the heart."

Treatment for P.A.D. includes exercise and a diet low in saturated and trans fats and cholesterol, in addition to blood pressure and cholesterol-lowering medications.

Rashad, who does not have P.A.D., is campaigning to make it part of regular health screenings. She is working on behalf of the Peripheral Arterial Disease Coalition, which is funded by the Bristol-Myers Squibb/Sanofi Aventis Partnership (both members are drug companies) and medical device maker Cordis Endovascular. The coalition has launched a website at www.padfacts.org.

"Growing up, I remember thinking when people got older they developed diabetes "because" they got older, or ... a heart attack or stroke "because" they got older, not because there was a buildup of plaque in the arteries, not because there was an obstruction of flow in the blood in the arteries leading to the legs, not because there was P.A.D.," Rashad said. ""Make the connection: legs to heart to brain."