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Peripheral Vascular Disease (PVD) Risk Assessment

Peripheral vascular disease is the most common disease of the arteries. It refers to any disease or disorder of the circulatory system outside of the brain and heart, and it affects about 10 million people in the United States—most over the age of 50. Are you at risk for PVD?

Are you at risk for Peripheral Vascular Disease (PVD)?

Please answer yes or no to the following questions:

1 Do you have a family history of diabetes or cardiovascular problems?
Yes
No
2 Do you currently have diabetes or cardiovascular problems?
Yes
No
3 Do you currently have high blood pressure?
Yes
No
4 Are you currently being treated for high cholesterol?
Yes
No
5 Do you experience impotence (men)?
Yes
No
6 Do you smoke?
Yes
No
7 Are you more than 25 lbs. overweight?
Yes
No
8 Do you eat fried or fatty foods three times a week or more?
Yes
No
9 Are you over the age of 50?
Yes
No
10 Do you have any of these symptoms:
Aching, cramping or leg pain in the legs while you walk or exercise, that goes away after rest?
Yes
No
Tingling, numbness or coldness in your hands or feet?
Yes
No
Loss of hair on your feet or toes?
Yes
No

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Mount Carmel Health System  |  Columbus, Ohio

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