Women Specific Characteristics and 1-Year Outcome Among Patients Hospitalized for Peripheral Artery Disease: A Monocentric Cohort Analysis in a Tertiary Center

Abstract

Although women have lower age-standardized cardiovascular disease incidence, prevalence, and death-related rates than men, there are also reports indicating that women with cardiovascular disease receive less care, fewer investigations, and have poorer outcomes after a coronary event. The aims of this study were to compare the characteristics of men and women hospitalized for peripheral artery disease (PAD), their cardiovascular and limb outcomes, and their 1-year mortality. The study is a prospective registry collecting data about all consecutive patients hospitalized for PAD within the vascular department of the tertiary center Georges-Pompidou European Hospital (Paris, France). Patients were required to have one of three inclusion criteria: previous revascularization of the lower limb or any lower limb artery occlusion due to an atherosclerotic vascular disease or hemodynamic evidence of PAD. Exclusion criteria were patients with lower extremity arterial occlusion due to another cause. All patients were followed-up for at least 12 months after the initial hospitalization. Among the 235 patients included, there were 61 women (26%), older than men with a median age of 75.6 and 68.3 years, respectively. Main cardiovascular risk factors and comorbidities were similar for men and women except more former or current smokers [145 (83.4%) vs. 33 (54.1%)] and more history of coronary heart disease [42 (24.1%) vs. 7 (11.5%)] in men. Most patients [138 (58.8%)] had critical limb ischemia and 97 (41.3%) had claudication, with no difference for sex. After discharge, 218 patients received an antithrombotic therapy (93.2%), 195 a lipid-lowering drug (83.3%), 185 an angiotensin converting enzyme inhibitor or angiotensin-receptor blocker (78.9%), similarly between sex. At 1-year, overall mortality, major adverse cardiovascular events, major adverse limb events did not differ with 23 (13.2%), 11 (6.3%) and 32 (18.4%) in men, and 8 (13.1%), 3 (4.9%), 15 (24.6%) in women, respectively, despite the difference in age. Overall mortality, cardiovascular outcomes, limb revascularization or amputation did not differ between men and women, 1-year after hospitalization for PAD although the latter were older, less smoker and had less coronary artery disease. Due to the small size of this cohort, larger studies and future research are needed to better understand sex-specific mechanisms in the pathophysiology and natural history of PAD.

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

“…To date, there is insu cient evidence or outdated data from surveys about sex-related differences in cardiovascular event rates in PAD populations [26]. Similarly to our report, a prospective trial conducted in a tertiary center in France showed no statistically signi cant differences between the two sexes in MALEs and MACEs among hospitalized patients with PAD at 1-year follow-up, despite women smoking less, having less CAD and having a trend for fewer MACE and increased MALE compared with men [27]. Sigvant et al showed that despite no sex differences in cardiovascular death risk in PAD patients, male patients had a one-third higher risk of all-cause mortality over a follow-up period of at least one year [28].…”

“…Thus, ascertaining sex-based disparities continue to be a challenge in PAD research, as women are still underrepresented in clinical and treatment trials, which may be partially related to the differences both in the nature and timing of clinical manifestations of atherosclerosis [24][25][26][27]. Indeed, although call-toaction initiatives have made progress, only around one-third of women currently participates in clinical trials and it results in small sample sizes of females and low statistical power for identifying remarkable sex-related outcome [25].…”

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

“…To date, there is insufficient evidence or data from surveys about sex-related differences in cardiovascular event rates in PAD populations [24]. Similarly to our report, a prospective trial conducted in a tertiary centre in France showed no statistically significant differences between the two sexes in MALEs and MACEs among hospitalized patients with PAD at 1-year follow-up, despite women smoking less, having less CAD and having a trend for fewer MACEs and increased MALEs compared with men [25]. Sigvant et al showed that, despite no sex differences in cardiovascular death risk in PAD patients, male patients had a one-third higher risk of all-cause mortality over a follow-up period of at least one year [26].…”

“…Thus, ascertaining sex-based disparities continues to be a challenge in PAD research, as women are still underrepresented in clinical and treatment trials, which may be partially related to the differences both in the nature and timing of clinical manifestations of atherosclerosis [4,[23][24][25]. Indeed, although call-to-action initiatives have made progress, only around one-third of women currently participate in clinical trials and this results in small sample sizes of females and low statistical power for identifying remarkable sex-related outcomes [23].…”

Exercise therapy for chronic symptomatic peripheral artery disease

“…Decreased detection and subsequent intervention may then result in a higher proportion of women with severe disease and chronic limb-threatening ischemia. Further, women who undergo revascularisation tend to be older and have more severe PAD compared to men, and these factors can affect outcomes of procedures adversely 177 . Contradictory results exist on women with PAD and mortality rates [178][179][180] .…”