Gender Differences in Health Status and Adverse Outcomes Among Patients With Peripheral Arterial Disease

Abstract

BackgroundFew studies have examined gender differences in health status and cardiovascular outcomes in patients with peripheral artery disease (PAD). This study assessed (1) self‐reported health status at PAD diagnosis and 12‐months later, and explored (2) whether outcomes in women with PAD differ with regard to long‐term major adverse events.Methods and ResultsA total of 816 patients (285 women) with PAD were enrolled from 2 vascular clinics in the Netherlands. Baseline clinical data and subsequent adverse events were recorded and patients completed the Short Form‐12 (SF‐12, Physical Component Score [PCS] and Mental Component Score [MCS]) upon PAD diagnosis and 12‐months later. Women had similar ages and clinical characteristics, but poorer socio‐economic status and more depressive symptoms at initial diagnosis, as compared with men. Women also had poorer physical (PCS: 37±10 versus 40±10, P=0.004) and mental (MCS: 47±12 versus 49±11, P=0.005) health status at the time of presentation. At 12‐months, women still reported a poorer overall PCS score (41±12 versus 46±11, P=0.006) and MCS score (42±14 versus 49±12, P=0.002). Female gender was an independent determinant of a poorer baseline and 12‐month PCS and MCS scores. However, there were no significant differences by gender on either mortality (unadjusted hazard ratio [HR]=0.93, 95% CI 0.60;1.44, P=0.74) or major adverse events (unadjusted HR=0.90, 95% CI 0.63;1.29, P=0.57), after a median follow‐up of 3.2 years.ConclusionsWomen's physical and mental health status is compromised both at initial PAD diagnosis and at 12‐month follow‐up, despite experiencing a similar magnitude of change in their health scores throughout the first 12‐months after diagnosis.

The effect of gender on outcomes after lower extremity revascularization

“…Women have also been found to have more depressive symptoms and poorer physical and mental health status scores at the initial diagnosis, suggesting they are more debilitated at the time of the intervention. 55 Even when we restricted our analysis to studies that matched men and women on preoperative risk factors for outcomes after intervention, we still identified higher postprocedure mortality and complications in women. This may still have been the result of residual confounding for the reasons mentioned above or it may be partly related to differences in biology between the sexes.…”

Peripheral Arterial Disease in Women: an Overview of Risk Factor Profile, Clinical Features, and Outcomes

“…In a longitudinal study of a large PAD population, women with PAD were found to have compromised health status both at diagnosis and 12 months after follow-up. The mechanism for poor health status in these women was thought to be associated with lower education and lack of social support (women were less likely to have a partner) [ 72 ].…”

Sex-Based Assessment of Patient Presentation, Lesion Characteristics, and Treatment Modalities in Patients Undergoing Peripheral Vascular Intervention

“…2, 5 Previous studies suggest that compared to men, women are treated at an older age, present with advanced multilevel disease, 1 have poorer overall health status, including more severe symptoms and lower quality of life, and are at increased risk for morbidity and mortality. 6…”

“…Solitary investigations examined several aspects of sex bias in therapy, but these were not the primary objective of investigations and were likely underpowered to determine sex-based differences. 6, 7 Furthermore, women remain an under-represented minority in most PAD studies, and many investigations have limited descriptions of clinical indications, treatment modalities, and disease distribution by sex. 2, 4, 7 These factors were highlighted by the American Heart Association’s call to evaluate sex-based differences in the presentation of PAD with a goal to identify the potential variation in treatment approaches, benefits and harms among men compared to women.…”