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

Abstract

Purpose of ReviewPeripheral arterial disease (PAD) is the third most common manifestation of cardiovascular disease (CVD), following coronary artery disease (CAD) and stroke. PAD remains underdiagnosed and under-treated in women.Recent FindingsWomen with PAD experience more atypical symptoms and poorer overall health status. The prevalence of PAD in women increases with age, such that more women than men have PAD after the age of 40 years. There is under-representation of PAD patients in clinical trials in general and women in particular. In this article, we address the lack of women participants in PAD trials. We then present a comprehensive overview of the epidemiology/risk factor profile, clinical features, treatment, and outcomes.SummaryPAD is prevalent in women and its global burden is on the rise despite a decline in global age-standardized death rate from CVD. The importance of this issue has been underlined by the American Heart Association’s (AHA) “Call to Action” scientific statement on PAD in women. Large-scale campaigns are needed to increase awareness among physicians and the general public. Furthermore, effective treatment strategies must be implemented.

Diabetes as a risk factor for incident peripheral arterial disease in women compared to men: a systematic review and meta-analysis

“…S5 and S6). Encouragingly, we found that, in each of the included studies, at least 50% of participants were women, even though historically women have been poorly represented in studies concerning PAD [1,36]. Clinical and public health implications Our study shows that diabetes is a risk factor for PAD, regardless of sex, and therefore that female sex is not protective against PAD in patients with diabetes.…”

“…S5 and S6). Encouragingly, we found that, in each of the included studies, at least 50% of participants were women, even though historically women have been poorly represented in studies concerning PAD [ 1 , 36 ].…”

Population Based Analysis of Gender Disparities in 23,715 Percutaneous Endovascular Revascularisations in the Metropolitan Area of Hamburg

“…8,22e24 Well known demographic developments may cause an increasing proportion of ageing female patients 25 in the future and there is already a verifiable trend when reviewing women in cardiovascular clinical trials between 1994 and 2017. 26 As a possible side effect of these demographic developments, it was found that female gender was an independent predictor of being transferred to a nursing home after revascularisation. It seems likely that a higher life expectancy of females when compared with males leads to differences in ambulatory care.…”

Geschlechterspezifische Unterschiede bei der endovaskulären Behandlung der peripheren arteriellen Verschlusskrankheit – Eine systematische Literaturübersicht

“…Dabei unterstreicht die zunehmende Anzahl an Publikationen über einen Zeitraum von mehr als 20 Jahren, dass diese Fragestellung für die Forschung weiterhin interessant und klinisch relevant ist. Obwohl Frauen fast die Hälfte der behan-deltenKohortenausmachen, istihrAnteil in prospektiven randomisierten Studien weiterhin ausgesprochen gering [26]. Es gibt zudem eindeutige Hinweise auf eine Unterversorgung mit leitliniengerechten Arzneimitteln bei Frauen, was einen Einfluss auf langfristige Behandlungsergebnisse nahelegt und die Hypothese begründet [44].…”

“…in Europa) [16,29] als Volkskrankheit und damit zu den wichtigsten Manifestationen der Atherosklerose. Obwohl Frauen in retrospektiven Beobachtungsstudien etwa 40 bis 50 % dieser Zielpopulation ausmachen, ist ihr Anteil in randomisierten Studien mit nur 20 % gering [26].…”