Lessons learned from the analysis of gender effect on risk factors and procedural outcomes of lower extremity arterial disease

Vouyouka, Ageliki G.; Egorova, Natalia; Salloum, Alexander; Kleinman, Lawrence C.; Marin, Michael L.; Faries, Peter L.; Moscowitz, Allan

doi:10.1016/j.jvs.2010.05.106

Cited by 121 publications

(96 citation statements)

References 37 publications

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“…Periinterventional success rates and long-term outcome seem to be similar in men and women. But female sex was associated with a higher rate of vascular access side complications such as bleeding [9,10]. Similar results are reported by Rieß et al with signifi cantly more bleeding complications requiring revision in women than in men.…”

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confidence: 58%

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The difference between men and women

Espinola‐Klein

2017

Vasa

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apy such as statins, anti-platelet medication, and angiotensin converting enzyme inhibitors are prescribed less frequently in women than in men [4]. Increased prevalence of asymptomatic PAD in women and less consequent risk factor management may contribute to more advanced disease and higher percentage of critical limb ischaemia at the time of diagnosis. A large publication including 1,797,885 patients (56 % male) from the USA confi rmed that women with PAD are older and more likely to present with critical limb ischaemia [8]. In contrast, in the study by Rieß et al. critical limb ischaemia with peripheral lesions was found more often in men than in women.In comparison to women men had more often interventions below the knee. This might be explained by the higher percentage of men with critical limb ischaemia and diabetes. A current publication including 12,379 patients who underwent lover extremity intervention found no gender diff erence in intervention above or below the knee [9]. Periinterventional success rates and long-term outcome seem to be similar in men and women. But female sex was associated with a higher rate of vascular access side complications such as bleeding [9,10]. Similar results are reported by Rieß et al. with signifi cantly more bleeding complications requiring revision in women than in men. This might be explained by risk factors for local complications such as older age, smaller vessel size, more calcifi ed arteries and increased number of comorbidities. In addition, in the present manuscript the percentage of obesity was higher in women than in men.Women were rather discharged to rehabilitation and had longer in-hospital stays. This could be explained by the more advanced age and the higher comorbidities of women when treated with endovascular procedures. Moreover vascular complications prolong in-hospital stays. In addition, because of advanced age women are more likely to live alone and need external help after hospital discharge.It should be remarked that there remains a selection bias in the manuscript by Rieß et al. Naturally they could only report the data from patients presented to the hospital with already diagnosed symptomatic PAD. In clinical practise Although the infl uence of gender on atherosclerosis in general is well known, there is only little information about its impact on peripheral artery disease (PAD). In particular many trials on treatment of PAD include only a small number of women [1,2]. This leads to the false assumption that PAD is mainly a male disease. In addition, women are usually older when they suff er from atherosclerotic disease and have more comorbidities, which has important implications on their treatment [1,2].Therefore the paper by Rieß et al. about gender diff erences in endovascular treatment of PAD adds important contributions to the literature [3]. They report data from 2,798 endovascular procedures conducted between September and November 2015 at 74 vascular centres in Germany. In total 61 % of the patients were male and more than half of the ...

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confidence: 58%

“…This results in a delayed diagnosis and treatment. Moreover because of the more advanced disease, women have a higher probability to present fi rst with critical limb ischaemia [4,[8][9][10]. We know from current data that a large amount of major amputations were performed in men and women without previous revascularisation [11].…”

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confidence: 99%

The difference between men and women

Espinola‐Klein

2017

Vasa

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“…Furthermore, signifi cantly more women were considered obese before undergoing treatment for CLI (p = .007). Along with observations from other studies, women tend to undergo an ER for PAD at an advanced state of the disease [8,9]. Several studies with focus on gender-specifi c diff erences on cardiovascular disease (CVD) have shown that women are generally sicker and show a higher in-hospital mortality when undergoing a coronary artery revascularization procedure [10].…”

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confidence: 95%

Gender differences in endovascular treatment of infrainguinal peripheral artery disease

Rieß

Debus

Heidemann

et al. 2017

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Summary:Background: Despite ongoing research concerning comorbidities and clinical presentation of peripheral arterial disease (PAD), the issue of gender associated differences in treatment is far from being settled. Patients and methods: This was a prospective, non-randomized multicentre study design. All patients suffering from intermittent claudication (IC) or critical limb ischaemia (CLI) were included. Results: A total of 2,798 procedures for symptomatic PAD in the infrainguinal region were recorded, with 1,696 (61.4 %) males. Distribution of comorbidities for patients with IC were gender-specifi cally different. Smoking was more common in men (41.9 vs. 31.9 %, p < .001), men had more often previous coronary heart disease (35.2 vs. 27.7 %, p = .007), and suffered more often from diabetes (33.9 vs. 28.2 %, p = .037). Women were generally older (71 vs. 77 years). Men were more prone to present with IC (46.9 vs. 43.6 %, p < .001) and ulcer/gangrene (43.6 vs. 41.2 %, p < .001). Women were more likely to present with rest pain (9.5 vs. 15.1 %, p < .001). Men were more often treated for a lesion below the knee (BTK) (21.1 vs. 14.9 %, p < .001), and females above the knee (ATK) (58.1 vs. 61.5 %, p < .001). Logistic regression analysis revealed a signifi cant association of male gender and treatment for lesions BTK (OR 1.565, 95 % CI 1.281-1.913, p < .001). Dissections and bleeding complications were more often observed in females with IC (3.3 vs. 7.2 %, p = 0.003; 0.4 vs. 1.5 %, p = 0.044). Women were rather discharged to rehabilitation and had a longer hospital stay compared to men (3.4 vs. 8.9 %, p < .001; three vs. four days, p = .023). Conclusions: The present study provides an overview on gender-specifi c differences in endovascular treatment of PAD. To date, available evidence on this topic is limited, emphasising the importance of further vascular research targeting this topic.

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“…34 Findings most concerning because female gender is a known, negative, independent risk factor for higher mortality for all major PV extremity surgery (amputation, revascularization). 35 Although PAD has higher prevalence in women, 36 women with PAD incur greater and more rapid functional decline than men. 37 Women with PAD have 2-3 times greater risk of stroke or MI, yet physicians neglect treating this major source of morbidity and mortality.…”

Section: 33mentioning

confidence: 99%

Because Women’s Lives Matter, We Need to Eliminate Gender Bias

2017

Critical Care Nurse

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Using written vignettes of homicides that differed only in sex of perpetrator, forensic psychiatrists and students diagnosed the defendant as legally insane significantly more often when perpetrator was a woman. 11World Health Organization 12 and US 13 research found most behavioral disorders (depression, anxiety) are diagnosed twice as often in women.Men receive more intensive treatments than women for common conditions. 14 85% of men vs 55% of women receive oral antihyperglycemics. 15 Despite the UK NICE guideline 27 13,16 (mandates "urgent referral to an oncologist" for painless macroscopic hematuria), 27% of women vs 10% of men had multiple consults before referral. Bladder cancer 5-year survival rate is 57% for men, 44% for women. 17,18 Female gender is independent risk factor for delayed referral and diagnosis of bladder and renal cancer. 19 TKA referral in patients with comparable osteoarthritis severity: physicians deny sex influences referral, but referral rate for men is 3 times that for women. Using identical standardized patients, 42% of physicians recommended TKA for the male, but not the female. Odds of primary care physicians recommending TKA for men was twice that for women; for orthopedic physicians, odds for men was 22 times that for women. 20Patients with osteoarthritis needing hip replacement, women less likely than men to receive 4 of 5 care stages: consult with general practitioner, specialist referral, orthopedic consult, wait listed. 21 Women have more disability before referral. 22Women have lower probability of referral to waiting list for kidney transplantation and longer delay between dialysis and waiting list compared to men. 23-25Women had significantly lower liver transplantation rates than men from 1997 to 2007 and greater deficit to men since. 26Women had pain years longer than men before referral to pain clinic, where women are prescribed minor tranquilizers, sedatives, or antidepressants vs analgesics and opioids for men. 27After abdominal surgery, physicians prescribed less pain medication for women compared to men; nurses gave less pain medication to women. 28After CABG, men received narcotics, women given sedatives. 29First report on gender attributes of pain: physicians minimized women's pain by attributing it to emotional causes. 30 80 physicians (44 men) and 113 nurses (103 women) more likely to treat male patients with opioids than females. Disparity greater for nurses than physicians. 31Despite ACC/AHA PAD guidelines, at discharge, women are significantly less likely than men to be prescribed 3 recommended therapies: statins, aspirin, and β-blockers. 32,33Women are offered surgical revascularization less often (36.4%) than men (53.8%) and are offered CEA less often at all ages. 34 When CEA is offered to women, it is often on a very delayed basis. Delays persist after adjusting for age, history, preoperative TIA, ABCD2 score, degree of stenosis, unilateral symptoms, and symptomatic stenosis. 34 Findings most concerning because female gender is a known, negative, independ...

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Lessons learned from the analysis of gender effect on risk factors and procedural outcomes of lower extremity arterial disease

Cited by 121 publications

References 37 publications

The difference between men and women

The difference between men and women

Gender differences in endovascular treatment of infrainguinal peripheral artery disease

Because Women’s Lives Matter, We Need to Eliminate Gender Bias

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