Challenges associated with peripheral arterial disease in women

Abstract

Peripheral arterial disease (PAD) is an increasingly recognized disorder that is associated with functional impairment, quality-of-life deterioration, increased risk of cardiovascular ischemic events, and increased risk of total and cardiovascular mortality. Although earlier studies suggested that PAD was more common in men, recent reports based on more sensitive tests have shown that the prevalence of PAD in women is at least the same as in men, if not higher. PAD tends to present itself asymptomatically or with atypical symptoms more frequently in women than in men, and is associated with comorbidities or situations particularly or exclusively found in the female sex, such as osteoporosis, hypothyroidism, the use of oral contraceptives, and a history of complications during pregnancy. Fat-distribution patterns and differential vascular characteristics in women may influence the interpretation of diagnostic methods, whereas sex-related vulnerability to drugs typically used in subjects with PAD, differences in risk-factor distribution among sexes, and distinct responses to revascularization procedures in men and women must be taken into account for proper disease management. All these issues pose important challenges associated with PAD in women. Of note, this group has classically been underrepresented in research studies. As a consequence, several sex-related challenges regarding diagnosis and management issues should be acknowledged, and research gaps should be addressed in order to successfully deal with this major health issue.

Focused Cardiovascular Care for Women

“…Atherosclerotic lower extremity PAD impairs walking performance 77 and is associated with not only a reduced quality of life 78,79 but also a markedly increased risk of CVD events and mortality. 80 Although male sex was traditionally believed to be a risk factor for PAD, recent studies 81,82 have reported compelling results on the high prevalence of PAD in women. At the extremes of ages <40 and >80 years), women represent a greater estimated population burden of PAD, affecting the lower extremities.…”

Sex differences in the outcomes of peripheral arterial disease: a population-based cohort study

“…Differences between women and men in the etiology and clinical presentation of PAD have also been suggested. 7 However, long-term data on sex-based differences in the cardiovascular and limb outcomes of patients with PAD are limited. Previous population-based studies have focused primarily on postoperative in-hospital outcomes, and their findings have been conflicting.…”

Amputation Risk in Patients with Diabetes Mellitus and Peripheral Artery Disease Using Statewide Data

“…This possibility, however, has been refuted by several studies that showed women tend to be diagnosed later with more advanced forms of PAD. 17,18 …”