Gender and Peripheral Arterial Disease

Abstract

Objective: The aim of this study is to determine gender differences in the risk factor profile and leg symptoms of peripheral arterial disease (PAD).Methods: We identified men and women with PAD from a cohort of patients within a primary care clinic setting. We screened patients 50 years of age and older. We diagnosed PAD based on an anklebrachial index (ABI) level of less than 0.9; the ABI is the ratio of ankle and arm systolic blood pressure measurements. Patients completed 4 questionnaires, one of which was used to ascertain leg symptoms related to compromised blood flow, the San Diego Claudication Questionnaire (SDCQ). Additional questionnaires were used to determine the patient's medical history, walking impairment, and health-related quality of life.Results: We enrolled 403 patients stratified by race and gender including 55 white women, 82 African American women, and 71 Hispanic women. There were no significant differences by gender in the prevalence of disease. The prevalence of PAD was 9.1% in white women, 21.9% in African American women, and 14.1% in Hispanic women (P ‫؍‬ .11). Risk factors for PAD were the same for women and men (ie, diabetes mellitus, current smoking, and use of blood pressure medication). Walking impairment subscale scores were lower for women with PAD when compared with women without PAD and to men with disease. Scores for physical function and general health were lower for women versus men with PAD.Conclusions Case IllustrationA 63-year-old African American woman with leg discomfort comes into your practice setting complaining of cramping in legs when she walks. Retired for 8 years, she goes walking at a shopping mall with a friend 2 times per week but she must stop several times and she is unable to keep up with her friend. Her leg symptoms resolve promptly with rest, and she has no rest pain or ulcerations. Additional medical history includes hypertension for which she has been prescribed hydrochlorothiazide at 25 mg per day and ramipril at 10 mg per day. She also takes aspirin at 81 mg per day. On physical examination, she weighs 165 lbs, waist circumference is 30 inches, height is 68 inches, blood pressure sitting is 130/85 and her pulse examination reveals a normal femoral and absent popliteal and pedal pulses on the right. On the left, her pulse examination reveals a normal femoral, an absent popliteal, and absent pedal pulses. Her resting ankle-brachial index is 0.70 for the left lower extremity and 0.74 for the right lower extremity. Her lipid profile reveals a total cholesterol of 225 mg/dL, and low-density lipoprotein of 160 mg/dL, and a high-density lipoprotein of 36 mg/dL. She has a normal glucose.

Ankle-to-Brachial Index and Dementia

“…33 However, the prevalence of PAD, defined by an ABI Ͻ0.90, has been shown to be higher in older women than men 34 or not to vary by gender. 35,36 No gender differences in the consequences of PAD have been reported. Third, results were not adjusted for the carotid intima-media thickness, which has been correlated to cognitive function 37 and reported to be a definite risk factor for myocardial infarction and stroke in older people.…”

A Call to Action: Women and Peripheral Artery Disease

“…29 In a primary care setting of men and women Ն50 years of age, women with PAD had poorer quality-of-life scores than men with PAD. 34 Several possible reasons have been hypothesized for the poorer functional performance among women with PAD than among men with PAD, including lower gender-based leg strength, poorer cardiopulmonary fitness, and reduced calf muscle hemoglobin oxygen saturation in women with PAD compared with men with PAD. 29,35,36 In prospective analyses, lower ABI values predict greater decline in walking-related disability among women.…”

“…27,31,32 Women with PAD have greater functional impairment than women without PAD. 28,33,34 Furthermore, women with PAD have greater lower extremity functional impairment than men. 29,34 -36 For example, in a cohort of 560 people with confirmed PAD and intermittent claudication, including 72 women, treadmill distance to onset of intermittent claudication symptoms was 33% shorter and maximal treadmill walking distance was 23% shorter in women than in men.…”

Artériopathie oblitérante des membres inférieurs chez la femme

“…À travers l'analyse de 3 cohortes, Wang et al [20] trouvent que les douleurs typiques et atypiques sont globalement plus fréquentes chez l'homme après ajustement à l'âge et aux facteurs de risque, mais comparées aux hommes, les femmes ont moins souvent une claudication typique que des douleurs atypiques. Dans une population de médecine générale, Collins et al [21] trouvent une distance de marche plus restreinte chez la femme claudicante que chez l'homme claudicant, mais ceci ne semble pas altérer plus particulièrement la qualité de vie des femmes artéritiques par rapport aux hommes souffrant de la même affection. En cas d'artériopathie, la fonction de marche, estimée par divers paramètres physiologiques, est plus altérée chez la femme [19].…”

“…Facteurs de risque d'artériopathie oblitérante des membres inférieurs : particularités chez la femme Facteurs de risque non liés au statut hormonal Concernant les facteurs de risque traditionnels (âge, tabagisme, hypercholestérolémie, hypertension, diabète), les études épidémiologiques ne retrouvent pas d'interaction entre le sexe et ces facteurs de risque associés à l'AOMI [21,33]. En d'autres termes, il semble qu'aucun de ces facteurs de risque ne soit plus ou moins délétère chez la femme que chez l'homme, en tant que facteurs contribuant au développement de l'AOMI.…”