What Causes P.A.D.? The most common cause of P.A.D. is atherosclerosis, a buildup of plaque in the arteries. The exact cause of atherosclerosis isn't known. Certain people are at higher risk for developing atherosclerosis. The disease may start if certain factors damage the inner layers of the arteries. These factors include - smoking  - high amounts of certain fats and cholesterol in the blood   - high blood pressure   - high amounts of sugar in the blood due to insulin resistance or diabetes. smoking high amounts of certain fats and cholesterol in the blood high blood pressure high amounts of sugar in the blood due to insulin resistance or diabetes. The major risk factors for P.A.D. are smoking, older age, and having certain diseases or conditions. The Effects of Smoking Smoking is the main risk factor for P.A.D. Your risk of P.A.D. increases four times if you smoke or have a history of smoking. On average, people who smoke and develop P.A.D. have symptoms 10 years earlier than people who don't smoke and develop P.A.D. Quitting smoking slows the progress of P.A.D. Smoking even one or two cigarettes a day can interfere with P.A.D. treatments. People who smoke and people who have diabetes are at highest risk for P.A.D. complications such as gangrene (tissue death) in the leg from decreased blood flow. Older Age Older age also is a risk factor for P.A.D. Plaque builds up in your arteries as you age. About 1 in every 20 Americans over the age of 50 has P.A.D. The risk continues to rise as you get older. Older age combined with other factors, such as smoking or diabetes, also puts you at higher risk for P.A.D. Diseases That Put You at Risk Many diseases and conditions can raise your risk of P.A.D., including - diabetes. About 1 in 3 people older than 50 who has diabetes also has P.A.D.  - high blood pressure   - high blood cholesterol   - coronary heart disease (CHD)   - stroke   - metabolic syndrome (a group of risk factors that raise your risk of CHD and other health problems, such as P.A.D., stroke, and diabetes).  diabetes. About 1 in 3 people older than 50 who has diabetes also has P.A.D. high blood pressure high blood cholesterol coronary heart disease (CHD) stroke metabolic syndrome (a group of risk factors that raise your risk of CHD and other health problems, such as P.A.D., stroke, and diabetes). A family history of these conditions makes P.A.D. more likely. Reducing Your Risk for P.A.D. Taking action to control your risk factors can help prevent or delay P.A.D. There are several helpful lifestyle changes you can make. - Quit smoking. Smoking is the biggest risk factor for P.A.D.  - Eat a healthy diet. Look for foods that are low in total fat, saturated fat, trans fat, cholesterol, and sodium (salt).  - Get regular exercise and physical activity. Quit smoking. Smoking is the biggest risk factor for P.A.D. Eat a healthy diet. Look for foods that are low in total fat, saturated fat, trans fat, cholesterol, and sodium (salt). Get regular exercise and physical activity. These lifestyle changes can reduce your risk for P.A.D. and its complications. They can also help prevent and control conditions such as diabetes and high blood pressure that can lead to P.A.D.