BY AMERICAN HEART ASSOCIATION NEWS

nathan creager 1960sLike many people of his generation, Nathaniel Creager spent the prime years of his life with a constant companion: cigarettes.

He fired through three packs of unfiltered Chesterfields daily for about 30 years. Later in life, after he’d finally quit, his legs hurt when he walked and he had a type of high blood pressure caused by kidney issues, something known as renal artery stenosis.

Yet he had something going for him – a son who recognized his symptoms as evidence of peripheral artery disease, or PAD. The elder Creager went to physicians who understood PAD and knew exactly how to treat it. They helped him live nearly three more decades, dying last year at age 91.

In his final year, he learned that his son, Mark, would become the president of the American Heart Association. And on Sunday, Dr. Creager delivered the most anticipated speech of his tenure, his Presidential Address. It kicked off Scientific Sessions 2015.

Formally titled “The Crisis of Vascular Disease and the Journey to Vascular Health,” Creager raised awareness about what’s being done and how much more is needed. As Nathaniel Creager’s son, he noted that this health crisis is personal.mark creager and father, Nathan

Creager, director of the Dartmouth-Hitchcock Heart and Vascular Center, the nonprofit academic health system connected with Dartmouth College’s medical school, has devoted his career to investigating vascular diseases.

He highlighted the fact that two significant vascular disorders, atherosclerosis and thrombosis, are key causes of heart disease and stroke, the two leading killers in the world. Those disorders also cause peripheral artery disease, which affects between 8 million to 10 million people in the United States and more than 200 million people across the globe.

The disease, he said, doesn’t discriminate, affecting men and women from low-, medium- and high-income countries. However, it is disproportionately present in some minority populations. There’s a greater prevalence in African-Americans than Caucasians, which is especially troubling since African-Americans are also at a higher risk of heart disease and stroke.

While PAD limits a person’s ability to walk, may require revascularization or could lead to amputation, it’s not simply a disease of the legs. Creager described it “as a clinical manifestation of a systemic disease.”

He further emphasized the devastation in terms of lives lost and money spent.

  • Up to 600,000 people are affected by venous thromboembolism each year, and it causes over 40,000 deaths.
  • Costs in this country for vascular-related complications in patients with PAD is more than $20 billion a year.
  • Healthcare costs for venous thromboembolism exceed $7.5 billion.

“Clearly,” he said, “the unrecognized epidemic of vascular disease requires our attention.”

ssmarkHe pointed to a study that showed that 75 percent of Americans don’t know of PAD. Worse still, he said, physicians often fail to diagnose it; those who do sometimes fail to treat it adequately.

This is a major concern because the risk of death is at least doubled for PAD patients, compared to those who don’t have it. And he said there are ways of helping – from antiplatelet drugs and statin therapy that can reduce risks of heart attack, stroke and cardiovascular death to supervised exercise training being shown to double walking distance.

He told the story of a middle-aged patient who regularly spent 30 minutes a day on the treadmill. Her reward to herself proved to be a trip to Disney World with her 5-year-old granddaughter, an experience she called “the most wonderful vacation of my life.” In a letter to Creager, the woman wrote: “Thank you for giving me back the will to continue walking.”

“It was one of those moments we are all grateful for – when we see our work change people’s lives,” he said. “It is moments like those that underscore our need to address vascular diseases.”

He emphasized the need for more research, noting that of the nearly 41,000 interventional trials registered in ClinicalTrials.gov in a three-year stretch ending in late 2010, fewer than 700 (about 1.7 percent) involved peripheral vascular diseases.

Creager closed by encouraging the thousands of healthcare professionals in the audience to “use your skills, knowledge and influence to help our patients, families, friends and colleagues improve their own vascular health and to enjoy richer, fuller lives.”

Scientific Session photo by Beth Langefels