A hidden problem: peripheral artery disease in women

Abstract

Peripheral artery disease (PAD) has a huge social and economic burden and is an important contributor to the global health burden. Sex differences in PAD are apparent, with recent data suggesting equal if not greater prevalence in women, and women having worse clinical outcomes. Why this occurs is not clear. To identify underlying reasons for gender inequalities in PAD, we executed a deeper exploration through a social constructive perspective. A scoping review was conducted using the World Health Organization model for analysis of gender-related needs in healthcare. Complex interacting factors, including biological, clinical, and societal variables, were reviewed to highlight gender-related inequities in the diagnosis, treatment, and management of PAD. Current gaps in knowledge were identified and insights into future directions aimed at improving these inequalities were discussed. Our findings highlight the multi-level complexities that need to be considered for strategies to improve gender-related needs in PAD healthcare.

Sex differences in outcomes after revascularization for acute lower limb ischemia: Propensity score adjusted analysis

“…Differences in the presentations of ALI as well as how resilient one is to the disease and treatment might also explain the seen difference. It is also important to recognize that, as identified in a recent study on PAD, several variables, including societal factors, are rarely explored as potential factors in sex‐based differences in an outcome 17 . Societal factors were not explored in the present study.…”

“…It is also important to recognize that, as identified in a recent study on PAD, several variables, including societal factors, are rarely explored as potential factors in sexbased differences in an outcome. 17 Societal factors were not explored in the present study. The absence of difference in outcomes between sexes might have been caused by an element of selection bias in only including those undergoing surgical or endovascular revascularizations.…”

Sex, Endothelial Cell Functions, and Peripheral Artery Disease

“…Differences in sex hormones may also affect arterial compliance, with post-menopausal females having increased arterial stiffness compared to males [13], a finding that is further exaggerated in conditions such as metabolic syndrome [14]. Arterial stiffness contributes to the increased prevalence of hypertension in women [15], and hypertension is a risk factor for PAD [16]. These differences in the biomechanical properties of arteries may affect the sex-dependent outcomes of PAD treatment.…”

Exploring the gender gap in surgical outcomes

“…The causes behind this are multifactorial and underpinned by a complex interplay of variables at a micro-(biology and environmental risk factors), meso-(education and employment), and macrolevel (women's roles in society). 2 Within cardiovascular surgery, women have been shown regularly to have poorer outcomes; notably after coronary artery surgery and aortic aneurysm repair. 3,4 Previous meta-analysis investigating gender differences in vascular surgery reported that women had an equal if not higher prevalence of peripheral arterial disease (PAD), more severe disease at presentation and often have poorer outcomes.…”

“…Unequal outcomes based on gender are reported widely in healthcare and often described as the gender gap. The causes behind this are multifactorial and underpinned by a complex interplay of variables at a micro‐ (biology and environmental risk factors), meso‐ (education and employment), and macrolevel (women's roles in society) 2 . Within cardiovascular surgery, women have been shown regularly to have poorer outcomes; notably after coronary artery surgery and aortic aneurysm repair 3,4 .…”