Does PAD Increase Your Risk of Coronary Artery Disease?

Yes, having peripheral artery disease significantly increases your risk of developing coronary artery disease. Both conditions stem from the same underlying disease process—atherosclerosis—and share many of the same risk factors. Understanding this connection can help you take action to prevent serious complications.

Below, we explain why PAD indicates CAD risk, what the statistics show, and what you can do to slow disease progression and reduce your cardiovascular risk.

What Is the Connection Between PAD and CAD?

Peripheral artery disease and coronary artery disease are both caused by atherosclerosis, a systemic disease where plaque builds up inside artery walls over time. The key word here is “systemic”—this means the disease process affects your entire circulatory system, not just one location.

In PAD, plaque narrows the arteries that supply blood to your legs and lower extremities. In CAD, plaque accumulates in the arteries that supply blood to your heart muscle. While these are different locations, they’re driven by the same underlying condition. If atherosclerotic plaque is building up in your leg arteries, it’s likely building up in other arteries throughout your body, including those that feed your heart.

Why Does PAD Indicate CAD Risk?

When doctors find PAD in a patient, it serves as a red flag for systemic cardiovascular disease. About 42 percent of patients with CAD also have peripheral artery disease, and conversely, many PAD patients develop CAD. This connection reflects the systemic nature of atherosclerosis.

Peripheral artery disease is a risk factor for non-fatal and fatal coronary disease and cerebrovascular events, with patients with PAD having the same relative risk of death from cardiovascular cause as those with coronary or cerebrovascular disease.

Shared Risk Factors

PAD and CAD develop due to overlapping risk factors. If you have multiple risk factors, your risk for both conditions increases significantly:

• Smoking — The single biggest risk factor for both conditions
• High cholesterol — Accelerates plaque buildup
• Diabetes — Damages artery linings and increases inflammation
• Hypertension — Stresses artery walls and promotes atherosclerosis
• Age — Risk increases after 50
• Family history — Genetic predisposition to atherosclerosis
• Chronic kidney disease — Associated with accelerated atherosclerosis
• Obesity — Increases inflammatory markers linked to vascular disease

How High Is Your Risk?

The statistics show a clear correlation between PAD and CAD development. In one study, coronary artery disease was present in 46.88% of PAD patients while only 20% of patients without PAD had CAD. This nearly 2.4-fold increase demonstrates how strongly PAD predicts CAD risk.

The risk of death in patients with PAD within 10 years is 4 times more than those without the disease. This elevated mortality risk reflects the systemic nature of atherosclerosis, indicating that having PAD means widespread vascular disease affecting multiple organ systems.

Statistics on PAD and CAD

The numbers underscore the importance of recognizing and treating PAD as a marker of systemic cardiovascular disease. The ankle brachial index (ABI), an index for occlusive vascular disease, is now considered an independent predictor of coronary and cerebrovascular morbidity and mortality. An ABI value below 0.9 indicates PAD, and such findings warrant cardiac evaluation.

Risk Factors That Matter Most

Not all risk factors carry equal weight. Smoking stands alone as the highest-risk modifiable factor. Smokers face the highest risk for both CAD and PAD, and quitting smoking lowers your risk dramatically and is the single best thing you can do for your overall health.

Metabolic factors like diabetes and high cholesterol also significantly influence both conditions. If you have high cholesterol, continuing cholesterol-lowering medications such as statins is important for lowering the risk for heart disease and stroke.

Can You Prevent CAD if You Have PAD?

Yes. While you cannot reverse existing atherosclerotic disease, early treatment and lifestyle modifications can slow progression, prevent complications, and reduce your risk of heart attack or stroke. The goal of PAD treatment is not just symptom relief, it’s cardiovascular risk reduction.

Treatment of PAD involves two parallel approaches: addressing the local arterial blockage and managing systemic risk factors to slow atherosclerotic progression throughout your body.

Treatment Options That Help

Minimally invasive procedures can restore blood flow in narrowed leg arteries. These treatments improve circulation and address the mechanical blockage:

• Endovascular Angioplasty — A balloon is inserted into the blocked artery and inflated to widen it, restoring blood flow. This can improve leg pain and walking ability.
• Stent Placement — After angioplasty, a mesh tube (stent) may be placed inside the artery to keep it open long-term and prevent re-narrowing.
• Atherectomy — A specialized catheter device removes plaque directly from the artery walls, improving blood flow without a balloon or stent.

These procedures improve symptoms and local blood flow, but the broader benefit comes from addressing your cardiovascular disease and taking steps to prevent complications. They should always be combined with risk factor management.

Lifestyle Changes

Lifestyle modifications are equally critical and address the root cause—atherosclerosis progression. The most important changes include:

• Stop smoking — This single action has the most dramatic impact on PAD and CAD progression
• Manage your cholesterol — Work with your doctor on statin therapy and dietary changes to lower LDL cholesterol
• Control blood pressure — High blood pressure accelerates atherosclerosis. Aim for target ranges recommended by your doctor
• Eat a heart-healthy diet — Reduce saturated fats, sodium, and processed foods. Emphasize vegetables, whole grains, and lean proteins
• Exercise regularly — Walking programs can improve PAD symptoms and cardiovascular health. Ask your doctor what level is safe for you
• Manage stress — Chronic stress contributes to atherosclerosis progression
• Maintain a healthy weight — Extra weight increases inflammation and cardiovascular risk

When Should You Get Tested?

If you have symptoms of PAD or multiple risk factors for cardiovascular disease, screening for both PAD and CAD is important. Don’t wait for symptoms to develop, as early detection allows for preventive treatment.

PAD Symptoms You Shouldn’t Ignore

Many people with early PAD have no symptoms, but as the disease progresses, signs may include:

• Leg pain or cramping during walking (claudication) that stops when you rest
• Weakness or numbness in the legs that may feel like heaviness or fatigue
• Cool or cold feet compared to the other leg or your hands
• Pale or bluish skin color on the legs or feet
• Slow-healing sores or wounds on the feet or legs
• Hair loss on the legs or feet
• Shiny skin on the lower legs

Diagnostic Tests

Your doctor can assess PAD risk with simple, non-invasive tests:

• Ankle-Brachial Index (ABI) Test — Compares blood pressure in your ankle to blood pressure in your arm. An ABI below 0.9 indicates PAD. This is non-invasive and painless.
• Duplex Ultrasound — Uses sound waves to visualize blood flow in arteries and identify blockages. No radiation involved.
• Angiography — If needed, this imaging shows the exact location and severity of blockages and helps plan treatment.

If PAD is confirmed, your doctor will likely recommend cardiac testing to assess CAD risk, which may include an EKG, stress test, or coronary angiography depending on your symptoms and risk profile.

What This Means for Your Heart Health

Having PAD is a message from your body that systemic atherosclerosis is present. It’s both a warning and an opportunity—a warning that you have significant cardiovascular disease, and an opportunity to intervene before a heart attack or stroke occurs.

The good news is that the same lifestyle changes and medications that treat PAD also benefit your heart. Statins lower cholesterol throughout your body. Blood pressure medications protect all your arteries. Exercise improves cardiovascular function everywhere. Quitting smoking reverses some of atherosclerosis’s damage.

If you are living with CAD, PAD, or both, you have a higher risk for heart disease and stroke. However, both CAD and PAD are caused by atherosclerosis, which results when cholesterol and fatty deposits called plaque build up in the artery walls. Managing atherosclerosis is therefore central to managing both conditions.

Frequently asked questions

Vascular screening and treatment

Lifestyle changes help. But they may not stop disease progression.

A healthier diet, regular exercise, and quitting smoking can slow atherosclerosis and reduce symptoms significantly. However, these changes alone may not be enough to prevent CAD if you have PAD. Early treatment of PAD itself—through minimally invasive procedures combined with medical management—addresses the root problem and reduces your risk of heart attack and stroke.

USA Vascular Centers offers image-guided, minimally invasive treatment for PAD performed by board-certified vascular specialists. Procedures are completed in an outpatient setting with no general anesthesia required and rapid recovery for most patients. Early evaluation and screening can identify vascular disease before complications develop.