Sex-Based Differences in Clinical Characteristics and Outcomes among Patients with Peripheral Artery Disease: A Retrospective Analysis

Abstract

Peripheral arterial disease (PAD) is a prevalent medical condition associated with high mortality and morbidity rates. Despite the high clinical burden, sex-based differences among PAD patients are not well defined yet, in contrast to other atherosclerotic diseases. This study aimed to describe sex-based differences in clinical characteristics and outcomes among hospitalized patients affected by PAD. This was a retrospective study evaluating all patients with a diagnosis of PAD admitted to the Emergency Department from 1 December 2013 to 31 December 2021. The primary endpoint of the study was the difference between male and female PAD patients in cumulative occurrence of Major Adverse Cardiovascular Events (MACEs) and Major Adverse Limb Events. A total of 1640 patients were enrolled. Among them, 1103 (67.3%) were males while females were significantly older (median age of 75 years vs. 71 years; p =< 0.001). Females underwent more angioplasty treatments for revascularization than men (29.8% vs. 25.6%; p = 0.04); males were treated with more amputations (19.9% vs. 15.3%; p = 0.012). A trend toward more MALEs and MACEs reported in the male group did not reach statistical significance (OR 1.27 [0.99–1.64]; p = 0.059) (OR 0.75 [0.50–1.11]; p = 0.153). However, despite lower extremity PAD severity seeming similar between the two sexes, among these patients males had a higher probability of undergoing lower limb amputations, of cardiovascular death and of myocardial infarction. Among hospitalized patients affected by PAD, even if there was not a sex-based significant difference in the incidence of MALEs and MACEs, adverse clinical outcomes were more common in males.

A Non-Coronary, Peripheral Arterial Atherosclerotic Disease (Carotid, Renal, Lower Limb) in Elderly Patients—A Review: Part I—Epidemiology, Risk Factors, and Atherosclerosis-Related Diversities in Elderly Patients

“…Every year in Poland, there are approximately 40,000 hospitalizations due to PAD and over 9000 amputations related to this disease [ 106 ]. Various diagnostic methods for detecting PAD have led to conflicting results in epidemiological studies [ 107 , 108 , 109 , 110 ]. Some studies suggest that males are slightly more prone to develop PAD than females.…”

“…The Rotterdam study, which was published in 1998 and based on ankle-brachial index (ABI) measurement, revealed that the incidence of PAD was greater in females than in males, with 20.5% of females and 16.9% of males affected [ 107 ]. There is a clear increase in incidence with age, ranging from 6.6% in males and 9.5% in females aged 55–59 years to 52.0% in males and 59.6% in females over the age of 85 years [ 107 , 108 , 109 , 110 ].…”

“…However, after PAD diagnosis, an estimated 20% of patients may experience MI, stroke, or death within the first 5 years. Critical ischemia of the lower limb resulting in amputation has the highest risk of death, and after amputation, the expected average survival time for 60% of patients is 2 to 5 years [ 106 , 107 , 108 , 109 , 110 ].…”