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Can You Have PAD Without High Cholesterol?

can you have pad without high cholesterol

High cholesterol appears on every list of risk factors associated with peripheral artery disease (PAD). PAD occurs when blood flow to the lower extremities is restricted due to the building up of plaque, known as atherosclerosis, in the arteries. Maybe you don’t have high cholesterol, but you’re worried about having PAD. Can you have PAD without high cholesterol?

If you have  warning signs and are concerned about peripheral artery disease, the vascular doctors at USA Vascular Centers can help. Our doctors are experts in diagnosing PAD, and they provide treatments that can enable you to live a fulfilling life. Please schedule a consultation with one of our doctors today. 


Signs & Symptoms 

Cholesterol is a type of waxy fat present in every cell. It is responsible for helping your body make Vitamin D, certain hormones, and acids to help with digestion. While cholesterol is vital to life, too much of it can cause problems. The body makes most of the cholesterol it needs. Still, many people eat foods high in cholesterol every day: red meat, full-fat dairy products, fried foods, and baked goods, to name a few. 

Eating foods rich in cholesterol isn’t necessarily a bad thing. However,  consuming more than 300 milligrams of cholesterol from food per day can raise your body’s cholesterol to unhealthy levels.1  There are two main types of cholesterol: low-density lipoprotein (LDL), or “bad” cholesterol, and high-density lipoprotein (HDL), or “good” cholesterol. The foods you eat can affect your good or harmful cholesterol levels. LDL causes plaque to build up on artery walls, resulting in atherosclerosis and peripheral artery disease. 

However, plaque contains more than just cholesterol: other fatty substances, calcium deposits, fibrin, and cellular waste products also contribute to plaque. Many patients with PAD have high cholesterol, a major contributing factor to peripheral artery disease. High cholesterol and PAD are linked, but can you have PAD without high cholesterol? This may be especially concerning if you have normal cholesterol levels but are still developing symptoms of PAD, such as: 

  • Pain in the legs while exercising (intermittent claudication)
  • A weak or absent pulse in the feet
  • Wounds in the feet, ankles, or legs that heal slowly or not at all

Additional symptoms include shiny skin on the lower extremities, slowed toenail growth, and loss of hair on the legs. If you have one or more of these symptoms yet  don’t have high cholesterol, you may ask yourself about PAD risk factors

Prevalent Risk Factors for Developing PAD

High cholesterol and PAD often  occur simultaneously, as high cholesterol is a significant risk factor for PAD. However, it is not the only factor. Let’s take a look at some of the most prevalent risk factors for developing PAD: smoking, diabetes, and high blood pressure. 


Cigarette smoke extract (CSE), the liquid solution that gets left in your body after you smoke, contains toxins that damage the cells lining the insides of your arteries. CSE also distorts an artery’s smooth muscle cells and causes inflammation. Recent studies suggest that these changes can be the sole cause for PAD, which may be why smoking is one of the leading risk factors.2  


Diabetes occurs when you have excess sugar and abnormal amounts of fats, or lipids (including cholesterol) in the blood. Diabetes can cause inflammation in the vascular system and damage the cells that line your arteries, as well as the smooth muscle cells in your arteries, putting you at risk for PAD.

High Blood Pressure

When the force of blood pushing against the walls of your blood vessels is too high for too long, you have high blood pressure, or hypertension. Over time, the force of your bloodstream can cause micro-tears in the inner walls of your arteries. Fats, calcium deposits, and other building blocks of plaque then get caught in these micro-tears and the scar tissue that forms after they heal. The arteries become narrower, increasing blood pressure, which results in more tears and more plaque buildup. Additional risk factors for PAD include high cholesterol, obesity, increased age, and genetics. 

Do all PAD Patients Have High Cholesterol?

Patients can have normal or near-normal cholesterol levels and still have peripheral artery disease. This is especially true if you smoke or use tobacco. Smoking can make your LDL cholesterol more sticky, allowing it to adhere to artery walls more easily. 

Smoking also lowers your HDL cholesterol. HDL cholesterol performs the important job of removing LDL cholesterol from the blood and even from artery walls, so if you don’t have enough of it, this can raise your LDL levels. In addition, smoking increases your heart rate and makes your blood denser, resulting in a slower blood flow and more opportunity for plaque to accumulate on artery walls.

When to See a Vascular Doctor

Regardless of your cholesterol levels, you should see a vascular doctor if you notice any PAD symptoms. However, even if you don’t have obvious signs of peripheral artery disease, it’s a good idea to get tested if you are at least 50 years old and have any of the risk factors for PAD, or if you are over the age of 65. Many PAD patients don’t show any symptoms, and even if they do, they may dismiss the pain or slow-healing wounds as a normal part of aging. 

Vascular doctors are highly skilled in diagnosing PAD and can detect clogged peripheral arteries using an ankle-brachial index (ABI) test, angiography, or vascular ultrasound. An ankle-brachial index test measures and compares the blood pressure in your arms and feet. Angiography uses a catheter, contrast dye, and X-ray imaging to take images, or angiograms, of your vascular system. Vascular ultrasound is a procedure where your doctor uses a small, handheld device called a transducer to take ultrasonic images of your blood vessels. 

A vascular doctor can prescribe  a treatment plan to address your peripheral artery disease. You may be encouraged to make lifestyle changes, such as beginning an exercise routine, quitting smoking, and starting a nutrition plan to help reduce PAD symptoms. 

You may also need a non-surgical treatment to remove plaque from affected arteries, including an angioplasty, stent placement, or atherectomy

Schedule a Consultation with USA Vascular Centers

If you’re anxious about having high cholesterol and PAD or think you may have PAD despite normal cholesterol levels, our vascular doctors at USA Vascular Centers can help. With the right treatment, you can continue to enjoy your family, friends, and favorite activities even while living with PAD. We encourage you to schedule a consultation with one of our compassionate vascular doctors online or call us at 888.773.2193 today.


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