Sex related differences in therapy and outcome of patients with intermittent claudication in a real-world cohort

Makowski, Lena; Feld, Jannik; Köppe, Jeanette; Illner, J; Kühnemund, Leonie; Wiederhold, A; Dröge, Patrik; Günster, Christian; Gerß, Joachim; Reinecke, Holger; Freisinger, Eva

doi:10.1016/j.atherosclerosis.2021.03.019

Cited by 21 publications

(13 citation statements)

References 31 publications

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“…PAD comprises a diverse group of disorders that lead to progressive stenosis, occlusion, or aneurysmal dilation of the aorta and its non-coronary branch arteries, including the carotid, upper extremity, visceral, and lower extremity arterial branches [6,7]. The prevalence of PAD is approximately 12% in the adult population, affecting >200 million people worldwide, and this prevalence is age-dependent, being males affected slightly more than females [8][9][10].…”

Section: Relevance Of Peripheral Artery Diseasementioning

confidence: 99%

Antithrombotic Therapy in Patients with Peripheral Artery Disease: A Focused Review on Oral Anticoagulation

Rivera‐Caravaca

Camelo-Castillo

Ramírez-Macías

et al. 2021

IJMS

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Peripheral artery disease (PAD) is a major cause of morbidity and mortality but it is usually underdiagnosed and undertreated. Patients with PAD present dysregulated procoagulant, anticoagulant, and fibrinolytic pathways leading to arterial and venous thrombosis. The risk of several ischemic-related complications could be mitigated with appropriate antithrombotic therapy, which plays a central role in all types of PAD. For years, antiplatelets have been indicated in patients with symptomatic PAD or those who have undergone revascularization. Unfortunately, a non-negligible proportion of patients with PAD will suffer from adverse events during the follow-up, even despite proper medical therapies for the prevention of PAD complications. Thus, there is room for improving clinical outcomes in these patients. Given the implication of both, primary and secondary hemostasis in arterial thrombosis and the pathophysiology of PAD, the combination of antiplatelets and anticoagulants has emerged as a potential antithrombotic alternative to antiplatelets alone. In this narrative review article, we have highlighted the most recent evidence about antithrombotic therapy in PAD patients, with a special focus on oral anticoagulation. Certainly, COMPASS and VOYAGER PAD trials have shown promising results. Thus, rivaroxaban in combination with aspirin seem to reduce cardiovascular outcomes with a similar bleeding risk compared to aspirin alone. Nevertheless, results from real-world studies are needed to confirm these observations, and other trials will provide novel evidence about the safety and efficacy of emerging anticoagulant agents.

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Section: Relevance Of Peripheral Artery Diseasementioning

confidence: 99%

Antithrombotic Therapy in Patients with Peripheral Artery Disease: A Focused Review on Oral Anticoagulation

Rivera‐Caravaca

Camelo-Castillo

Ramírez-Macías

et al. 2021

IJMS

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“…In addition to observing great variability in prescribing between different countries and medical specialties, elderly patients and patients with typical symptoms were less likely and more likely, respectively, to have their treatment intensified ( 170 ). In addition to age ( 19 ), it appears that sex also influences the prescribing of statins in patients with PAD, such that men were more likely to receive statins than women ( 19 , 172 – 174 ), although this does not translate into better LDL-C targets ( 172 ).…”

Section: Statin Prescription Rate In Patients With Peripheral Arterial Diseasementioning

confidence: 99%

Statins and Peripheral Arterial Disease: A Narrative Review

Jansen-Chaparro

López-Carmona

Cobos-Palacios

et al. 2021

Front. Cardiovasc. Med.

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Peripheral arterial disease (PAD) is a highly prevalent atherosclerotic condition. In patients with PAD, the presence of intermittent claudication leads to a deterioration in quality of life. In addition, even in asymptomatic cases, patients with PAD are at high risk of cardiac or cerebrovascular events. Treatment of PAD is based on lifestyle modifications; regular exercise; smoking cessation; and control of cardiovascular risk factors, including hypercholesterolemia. A growing number of studies have shown that statins reduce cardiovascular risk and improve symptoms associated with PAD. Current guidelines recommend the use of statins in all patients with PAD in order to decrease cardiovascular events and mortality. However, the prescribing of statins in patients with PAD is lower than in those with coronary heart disease. This review provides relevant information from the literature that supports the use of statins in patients with PAD and shows their potential benefit in decreasing lower limb complications as well as cardiovascular morbidity and mortality.

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“…This is probably caused due to the fact that women more often present with borderline ABI and longer symptom-free periods compared with their male counterparts. 19–21 In IC patients, approximately two-thirds of the patients are male, 22 , 23 while in CLTI patients, the prevalence is only marginal lower in women compared with men. 16 , 24–26 Various studies have shown that women are older 23 , 27 , 28 and older patients, as well as women, receive less often guideline-recommended medication.…”

Section: Introductionmentioning

confidence: 99%

“… 19–21 In IC patients, approximately two-thirds of the patients are male, 22 , 23 while in CLTI patients, the prevalence is only marginal lower in women compared with men. 16 , 24–26 Various studies have shown that women are older 23 , 27 , 28 and older patients, as well as women, receive less often guideline-recommended medication. 29 In addition, women receive less often any revascularization, while endovascular approaches were more often in female patients.…”

Section: Introductionmentioning

confidence: 99%

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Sex-related differences in treatment and outcome of chronic limb-threatening ischaemia: a real-world cohort

Makowski

Köppe²,

Engelbertz

et al. 2022

European Heart Journal

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Aims The prevalence of chronic limb-threatening ischaemia (CLTI) is increasing and available data often derive from cohorts with various selection criteria. In the present study, we included CLTI patients and studied sex-related differences in their risk profile, vascular procedures, and long-term outcome. Methods and results We analysed 199 953 unselected patients of the largest public health insurance in Germany (AOK: Local healthcare funds), hospitalized between 2010 and 2017 for a main diagnosis of CLTI. A baseline period of 2 years before index hospitalization to assess comorbidities and previous procedures, and a follow-up period until 2018 were included. Female CLTI patients were older (median 81.4 vs. 73.8 years in males; P < 0.001) and more often diagnosed with hypertension, atrial fibrillation, chronic heart failure, and chronic kidney disease. Male patients suffered more frequently from diabetes mellitus, dyslipidaemia, smoking, cerebrovascular disease, and chronic coronary syndrome (all P < 0.001). Within hospitalized CLTI patients, females represent the minority (43% vs. 57%; P < 0.001) and during index hospitalization, women underwent less frequently diagnostic angiographies (67 vs. 70%) and revascularization procedures (61 vs. 65%; both P < 0.001). Moreover, women received less frequently guideline-recommended drugs like statins (35 vs. 43%) and antithrombotic therapy (48 vs. 53%; both P < 0.001) at baseline. Interestingly, after including age and comorbidities in a Cox regression analysis, female sex was associated with increased overall-survival (OS) [hazard ratio (HR) 0.95; 95% confidence interval (CI) 0.94–0.96] and amputation-free survival (AFS) (HR 0.84; 95% CI 0.83–0.85; both P < 0.001). Conclusion Female patients with CLTI were older, underwent less often vascular procedures, and received less frequently guideline-recommended medication. Nevertheless, female sex was independently associated with better OS and AFS during follow-up. Key question Analysis of sex-related differences in patients with chronic limb-threatening ischaemia (CLTI), with a focus on their risk profile, treatment, and long-term outcome. Key finding Female CLTI patients were older, underwent vascular procedures less often, and received less frequently guideline-recommended drugs, but female sex was associated with better outcome. Take-home message Chronic limb-threatening ischaemia should be considered as a multi-organ disease with an ever increasing prevalence and a poor prognosis. Chronic limb-threatening ischaemia patients partly do not receive optimal therapy, and this is more prominent in females.

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Sex related differences in therapy and outcome of patients with intermittent claudication in a real-world cohort

Cited by 21 publications

References 31 publications

Antithrombotic Therapy in Patients with Peripheral Artery Disease: A Focused Review on Oral Anticoagulation

Antithrombotic Therapy in Patients with Peripheral Artery Disease: A Focused Review on Oral Anticoagulation

Statins and Peripheral Arterial Disease: A Narrative Review

Sex-related differences in treatment and outcome of chronic limb-threatening ischaemia: a real-world cohort

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