Gender specific differences in peripheral artery disease and their impact on cardiovascular rehabilitation -the experience of a Romanian Rehabilitation Hospital

Abstract

Introduction. As the prevalence of peripheral artery disease (PAD) is increasing in developing countries, so are the healthcare and socio-economic costs it brings about. This particular form of atherosclerotic disease is very much age-dependent, and along with the increase in life-expectancy, the lasts decades have seen a sharp rise in PAD prevalence in women. Knowledge regarding genderspecific aspects of the disease are scarce. This has a negative effect on overall outcomes of female PAD patients. Aim. This research aimed to identify gender peculiarities of PAD and evaluate their impact on cardiovascular rehabilitation. Material and methods. This was a retrospective observational study of 104 PAD patients (73 men and 31 women) admitted in 2016 to the Cardiology department of the Rehabilitation Hospital Cluj-Napoca. Demographic, clinical and biological parameters were recorded, as well as the treatment/rehabilitation regimens prescribed. The subjects were divided into to groups according to gender. Statistical analysis was done using the student t-test for unequal variances, hi-square test and the stepwise method for multivariate analysis. Results. The female group had a higher prevalence of diabetes mellitus (45% vs 33%, p=ns), but men were more likely smokers (74% vs 51%-p=0.017). Women had higher median total cholesterol values (p=0.006) and lower HDL-cholesterol levels (p=0.033). More than half of the female patients were already experiencing symptoms of critical limb ischemia on admission (57%), while intermittent claudication was predominant with men (66%). Multivariate analysis identified identified female gender (p=0.028) and ABI (p<0.0001) as sole independent predictors for the severity of the disease. Revascularization using percutaneous techniques was the preferred option for women (35% vs 27%), while surgery was performed more often in men (38% vs 29%)-p=ns. Home-based exercise training was indicated on discharge for more than half of the male group while only 30% of women had physical rehabilitation as a first line of treatment. Discussion. Our research offered similar findings to older studies regarding the genderspecific profile of PAD women, showing they are less exposed to smoking but more likely to experience metabolic disorders. Women had higher rates of critical limb ischemia on admission, suggesting a more advanced disease. Because of a more stable disease in men, this category benefited to a greater extent from exercise training compared to women. Conclusion. Peripheral artery disease has specific gender-related differences that in women have an important impact on both diagnosis and management, impeding rehabilitation and full social reintegration.