Differences in Symptom Presentation in Women and Men with Confirmed Lower Limb Peripheral Artery Disease: A Systematic Review and Meta-Analysis

Porras, Cindy P.; Bots, Michiel L.; Teraa, Martin; Doorn, Sander van; Vernooij, Robin W.M.

doi:10.1016/j.ejvs.2021.12.039

Cited by 19 publications

(24 citation statements)

References 54 publications

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“…The incidence of PAD appears largely affected by the demographics of the observed cohort, including ethnicity, age, sex, and presence of comorbidities [ 9 , 27 , 28 , 29 ]. This study used patient level data, and this approach differs with large administrative databases or insurance claim data.…”

Section: Discussionmentioning

confidence: 99%

“…Male sex has long been associated with higher rates of PAD; however, globally the prevalence appears higher in women [ 30 ]. Women present more often with rest pain and atypical leg symptoms [ 29 ], whereas men present with more severe disease demonstrated by lower ABI, IC and CLTI symptomology [ 7 , 31 ]. Our study suggests that males within the Midland region present either more typically or severely with PAD to initiate surgical intervention.…”

Section: Discussionmentioning

confidence: 99%

“…Our study suggests that males within the Midland region present either more typically or severely with PAD to initiate surgical intervention. Women were slightly older when undergoing their first PAD-related procedure, and a recent metanalysis reflects this, reporting that females were 2.25 years older at presentation [ 29 ]. However, studies report that male sex is associated with a 13% relative increase in all-cause mortality for patients with PAD [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

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The Incidence of Chronic Limb-Threatening Ischemia in the Midland Region of New Zealand over a 12-Year Period

Hart

Xue

Davis-Havill

et al. 2022

JCM

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The epidemiology of severe PAD, as characterized by short-distance intermittent claudication (IC) and chronic limb-threatening ischemia (CLTI), remains undefined in New Zealand (NZ). This was a retrospective observational cohort study of the Midland region in NZ, including all lower limb PAD-related surgical and percutaneous interventions between the 1st of January 2010 and the 31st of December 2021. Overall, 2541 patients were included. The mean annual incidence of short-distance IC was 15.8 per 100,000, and of CLTI was 36.2 per 100,000 population. The annual incidence of both conditions was greater in men. Women presented 3 years older with PAD (p < 0.001). Patients with short-distance IC had lower ipsilateral major limb amputation at 30 days compared to CLTI (IC 2, 0.3% vs. CLTI 298, 16.7%, p < 0.001). The 30-day mortality was greater in elderly patients (<65 years 2.7% vs. ≥65 years 4.4%, p = 0.049), but did not differ depending on sex (females 36, 3.7% vs. males 64, 4.1%, p = 0.787). Elderly age was associated with a worse survival for both short-distance IC and CLTI. There was a worse survival for females with CLTI. In conclusion, PAD imposes a significant burden in NZ, and further research is required in order to reduce this disparity.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The Incidence of Chronic Limb-Threatening Ischemia in the Midland Region of New Zealand over a 12-Year Period

Hart

Xue

Davis-Havill

et al. 2022

JCM

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“…Women with LEAD have a higher frequency to be asymptomatic [25] or present with either rest pain or atypical leg symptoms; [10] these factors could contribute to a delay in diagnosis and a worse prognosis. However, it was unclear whether this phenomenon could also be partially explained by differences in the number of GP contacts prior to the diagnosis of LEAD and by delays in referral to a hospital specialist.…”

Section: Discussionmentioning

confidence: 99%

“…It affects over 236 million people worldwide (52.23% women) [5] and is associated with a very high risk for major adverse cardiovascular (MACE) and limb events (MALE) [6]. Previous studies have shown that women with LEAD present symptoms differently, are often underdiagnosed or not diagnosed expeditiously, and have a worse prognosis for life and limb [7][8][9][10]. Egorova et al found that women are consistently less likely to be hospitalized for LEAD but are more prone than men to be admitted urgently.…”

Section: Introductionmentioning

confidence: 99%

The Frequency of Primary Healthcare Contacts Preceding the Diagnosis of Lower-Extremity Arterial Disease: Do Women Consult General Practice Differently?

Porras

Teraa

Bots

et al. 2022

JCM

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Background. Women with lower-extremity arterial disease (LEAD) are often underdiagnosed, present themselves with more advanced disease at diagnosis, and fare worse than men. Objective. To investigate to what extent potential gender differences exist in the frequency and reasons for general practitioner (GP) consultation six months prior to the diagnosis of LEAD, as potential indicators of diagnostic delay. Methods. Individuals older than 18 years diagnosed with LEAD, sampled from the Julius General Practitioner’s Network (JGPN), were included and compared with a reference population, matched (1:2.6 ratio) in terms of age, sex, and general practice. We applied a zero-inflated negative binomial (ZINB) regression model. Results. The study population comprised 4044 patients with LEAD (43.5% women) and 10,486 subjects in the reference population (46.3% women). In the LEAD cohort, the number of GP contacts was 2.70 (95% CI: 2.42, 3.02) in women and 2.54 (2.29, 2.82) in men. In the reference cohort, 1.77 (95% CI: 1.62, 1.94) in women and 1.63 (CI: 1.50, 1.78) in men. In the LEAD cohort, 21.9% of GP contacts occurred one month prior to diagnosis. In both cohorts and both sexes, the most common cause of consultation during the last month before the index date was cardiovascular problems. Conclusions. Six months preceding the initial diagnosis of LEAD, patients visit the GP more often than a similar population without LEAD, regardless of gender. Reported gender differences in the severity of LEAD at diagnosis do not seem to be explained by a delay in presentation to the GP.

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Contemporary Treatment and Outcome of Patients with Ischaemic Lower Limb Amputation: A Focus on Sex Differences

Makowski¹,

Engelbertz²,

Köppe³

et al. 2023

European Journal of Vascular and Endovascular Surgery

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Differences in Symptom Presentation in Women and Men with Confirmed Lower Limb Peripheral Artery Disease: A Systematic Review and Meta-Analysis

Cited by 19 publications

References 54 publications

The Incidence of Chronic Limb-Threatening Ischemia in the Midland Region of New Zealand over a 12-Year Period

The Incidence of Chronic Limb-Threatening Ischemia in the Midland Region of New Zealand over a 12-Year Period

The Frequency of Primary Healthcare Contacts Preceding the Diagnosis of Lower-Extremity Arterial Disease: Do Women Consult General Practice Differently?

Contemporary Treatment and Outcome of Patients with Ischaemic Lower Limb Amputation: A Focus on Sex Differences

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