A reader in East Sussex with arterial problems in his legs asks if his doctor is being alarmist by insisting he take the treatment recommended for patients with suspect coronary arteries. Can pain in the legs when walking, cold feet and a poor pulse in his feet truly give evidence of an increased risk of a heart attack?

The reader is lucky to have a doctor who takes peripheral arterial disease seriously. The most readily recognised manifestation of the disease is intermittent claudication, pain in the legs on walking. Patients first notice this when walking briskly up a hill, especially if they are doing so on a cold day. The pain is cramping and may affect one or both calves. Characteristically the pain goes after a moment or two if the patient has a brief rest. Older people climbing a hill in a town will often pause every few yards and pretend to look in shop windows. In reality they are waiting for the intermittent claudication to wear off.

Sometimes the cramping pain may be in the thighs. The feet are unusually cold. The legs are relatively or completely hairless and the skin shiny as the result of poor circulation. The clinching factor in making the diagnosis of intermittent claudication is a feeble, difficult-to-feel pulse in the foot. Although the condition is the most frequently reported first sign of peripheral arterial disease, impotence is probably as common and is as frequently the first sign of coronary arterial disease as is angina – chest pain on exercise.

Another type of peripheral arterial disease is the narrowing of carotid arteries, those that lead to the brain. When they become excessively narrowed the patient is most likely to suffer a TIA, a transient small stroke in which the symptoms wear off within 24 hours. Atheromatous cardiovascular disease, a furring up of the arteries, may also affect the aorta, the main artery leading from the heart.

Recent research has shown that the presence of peripheral arterial disease is more closely associated with death from a stroke or heart attack than either angina, coronary artery pain or a TIA. Patients with the disease should be as vigorously treated as those with angina.