The risk factors we address, and what each one means
These definitions follow the American College of Cardiology and American Heart Association guidelines. Your own numbers are reviewed at every visit.
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Nicotine and tobacco use. Any current use of cigarettes, cigars, chewing tobacco, vaping, or nicotine pouches. Nicotine dependence is a chronic, relapsing medical condition rather than a failure of will. Tobacco is the strongest single risk to your arteries, and stopping is a Class 1 recommendation in the 2024 guideline for peripheral artery disease — the strongest category the guidelines use.
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Marijuana use. Regular use of cannabis in any form. This one is different from the others: no cardiology guideline yet sets a treatment recommendation for it, because the evidence is observational rather than from randomized trials. What the evidence shows is an association between regular use and heart attack, stroke, and heart failure, strong enough that American College of Cardiology investigators now advise asking about it the same way we ask about cigarettes. We ask, and we tell you plainly where the evidence is solid and where it is not.
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High blood pressure (hypertension). Defined by the 2025 guideline on the average of at least two careful readings taken on at least two occasions: normal is under 120/80; elevated is 120 to 129 with a bottom number under 80; stage 1 is 130 to 139 or 80 to 89; stage 2 is 140 or higher, or 90 or higher. The upper number is the pressure while the heart squeezes; the lower number is the pressure between beats.
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High cholesterol (hyperlipidemia). The number that matters most is LDL cholesterol, the fraction that builds plaque inside artery walls. There is no single cut-off that separates normal from abnormal: the treatment threshold depends on what else is true of you. An LDL of 190 or above is severe elevation on its own, and for anyone with artery disease already diagnosed, treatment is recommended regardless of the starting number.
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Type 2 diabetes mellitus. Diagnosed by any one of four standard measurements: a hemoglobin A1c of 6.5% or higher, which reflects average blood sugar over about three months; a fasting glucose of 126 or higher; a two-hour glucose of 200 or higher on a glucose tolerance test; or a random glucose of 200 or higher with symptoms. Diabetes damages the small arteries of the foot in particular, which is why it so often decides whether a wound heals.
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Chronic kidney disease. Kidney function below 60 on the estimated glomerular filtration rate, or protein in the urine at or above 30 milligrams per gram, present for at least three months. Reduced kidney function accelerates artery calcification and changes how a procedure has to be planned.
Some risk factors cannot be changed — age, sex, and family history — and they matter because they raise how aggressively everything above should be treated. How each of these is treated →
Sources: 2024 ACC/AHA multisociety guideline for lower extremity peripheral artery disease (doi:10.1161/CIR.0000000000001251); 2025 ACC/AHA guideline for high blood pressure in adults (ACC summary). This page describes how care is managed and is not a substitute for your own physician’s judgment about your medicines.
Tobacco and nicotine: the strongest single risk
Nothing damages your arteries, or undoes the benefit of treatment, faster than tobacco and nicotine. Quitting is the single most powerful thing you can do for your legs, your heart, and your life.
What it is
Nicotine dependence is a chronic, relapsing medical condition, not a character flaw. Nicotine reaches the brain within seconds of an inhalation and rewires reward and stress circuits to expect it. That is why quitting is hard for people with enormous discipline in every other part of their lives, and why the number of attempts before success is measured in handfuls rather than ones.
The delivery vehicle varies — cigarettes, cigars, chewing tobacco, vaping, pouches. The nicotine, and its effect on your arteries, does not.
Why it matters
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It accelerates the plaque buildup that narrows arteries throughout the body
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It constricts blood vessels and worsens circulation to the legs and feet
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It slows wound healing and raises the risk that a treated artery narrows again
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It increases the risk of heart attack, stroke, and amputation
Of everything on this website — every procedure, every device, every medication — stopping nicotine is the intervention with the largest effect on your arteries. It is also the only one you administer yourself.
Treatment Options
Medical and conservative therapy
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Behavioral counseling, individual or by quitline. Effective on its own, and more effective with medication.
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Nicotine replacement — patch, gum, lozenge, inhaler, nasal spray. Combining a long-acting patch with a short-acting form works better than either alone.
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Varenicline and bupropion, prescription medications that reduce craving and withdrawal.
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Setting a quit date and planning for the specific situations that will test it.
Counseling plus medication works better than either alone, and better than willpower by itself. Relapse is part of the process, not the end of it.
Free help, anytime.
The national quitline — 1-800-QUIT-NOW (1-800-784-8669) — offers free, confidential coaching. Oklahoma residents can reach the Oklahoma Tobacco Helpline the same way.
We will also help connect you with support and, when appropriate, prescribe medication. Ask us, or ask your primary care physician. Even after decades of smoking, quitting begins to help your circulation, and it protects every procedure we perform. Managing your PAD →
Quitting is hard, and willpower alone is rarely the whole answer. You do not have to do it alone.