Peripheral Artery Disease: Why Do Women Have Worse Outcomes Than Men?

Later diagnosis, advanced disease more likely with women

As a woman, you likely know that regular examinations and tests can help you and your doctor watch out for breast and cervical cancers. But there’s another common, but lesser-known, condition that requires the same diligent watchfulness, especially for women: peripheral artery disease (PAD).

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PAD happens when plaque builds up in the blood vessels of your legs and, less commonly, your arms. Unfortunately, you may not notice any symptoms.

In fact, you may have PAD and not know it. For women, diagnosis usually comes later, the condition progresses more quickly and outcomes are worse than for men who have PAD.

No one knows exactly why this is true. Cardiologist Maya Serhal, MD, answers some of our questions about potential risk factors and how to slow progression of the disease.

Q: What do people need to know about PAD diagnosis?

A: The most important thing patients should understand about PAD is that it is incredibly under-recognized. I don’t think we (doctors) knew about this until a large trial several years ago. It showed that it’s more common than we gave it credit for and many patients don’t show any symptoms.

Q: If many patients don’t have symptoms, why is diagnosis often later for women than for men?

A: A vast majority of men and women — about 60 percent — present with atypical or no symptoms. But as recognition of the condition has grown, we know that women are often more asymptomatic than men.

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The classic symptom is pain with exertion. Women tend to have pain at rest, which we normally only see with severe PAD.

Q: Studies show that women do worse with interventions than men do. Why is that?

A:Unfortunately, studies to date have predominantly enrolled men. As a result, data pertaining to outcomes in women is relatively limited. Additionally, it is unclear if there may be some gender-specific risk factors for PAD.

Some data shows increased inflammatory markers in women post-bypass surgery being associated with graft failure, wounds, or limb loss. However, this data is relatively limited.

Q: Does the disease affect women differently than men?

A: Women may be diagnosed with PAD when their disease is more advanced. PAD appears to progress faster in women and it has notable effects on their quality of life. Additionally, women develop symptoms with shorter periods of walking compared to men.

Q: What else do women need to know about diagnosis of PAD?

A: PAD is more common than commonly found cancers in women, such as cervical and breast cancer. Women need to be aware of the risk factors for PAD, which include:

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  • Family history of PAD
  • High blood pressure
  • High cholesterol
  • Diabetes
  • Smoking

As we age, the risk of PAD increases.

Q: What are other symptoms of PAD?

A: A variety of symptoms can occur with PAD. Most classically, patients experience a burning sensation in the legs that occurs with exertion and resolves with rest. However, other symptoms can include fatigue or heaviness in the legs. There may be hair loss in the legs. Color or temperature changes in the feet can occur. Patients may also note more slow healing ulcerations or wounds.

Q: Why is it important to catch PAD as early as possible?

A: PAD is strongly associated with cardiovascular morbidity or mortality. If you have PAD, there are a variety of medical therapies that can help reduce your risk of heart attack, stroke and limb loss. Additionally, risk factor modification is important — such as quitting smoking, controlling your blood cholesterol and blood pressure and aggressively managing diabetes.

If you have concerns about PAD, it is important to address your concerns with your doctor. If you have risk factors, including coronary artery disease, smoking, high blood pressure, hyperlipidemia, or diabetes, with classic or vague symptoms, a discussion with your provider regarding your concerns is very important. A variety of non-invasive tests can screen for PAD.

Awareness of PAD is fundamental in reducing progression of the disease.

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