Purpose:
Little is known about the existence of potential gender disparities in
peripheral arterial occlusive disease. To our knowledge, this is the first
study to analyze differences attributed to gender in type-2 diabetic
patients with symptomatic peripheral arterial occlusive disease, with regard
to clinical presentations, risk factors and anatomical distributions of
atherosclerosis.
Patients and methods:
This study was conducted at King Abdullah University Hospital, Jordan.
Medical records of all diabetic (type-2) patients who presented with
symptomatic peripheral arterial occlusive disease in the period from January
2012 and November 2017 were reviewed, data were collected retrospectively.
In all, 364 patients (282 males and 82 females) were involved. Criteria for
diagnosis include the following Ankle-Brachial Index ⩽ 0.9 and intermittent
claudication or critical limb ischemia. Risk factors for atherosclerosis
(age, smoking and hypertension) and computed tomography-angiogram findings
were analyzed using Statistical Package for the Social Sciences. p < 0.05
was considered statistically significant.
Results:
The mean age was higher in females than males (67.61 vs 62.61 years; p =
0.001). Females had greater prevalence of uncontrolled diabetes compared to
males (HbA1c 9.07 in females vs 8.51 in males; p = 0.03). High density
lipoprotein was higher in females than males (1.02 vs 0.935; p = 0.009).
Females presented more with critical limb ischemia than intermittent
claudication in comparison with males (p = 0.017). Involvement of
superficial femoral artery, deep femoral artery and peroneal artery in
hemodynamic relevant atherosclerotic lesion was significantly higher in
females than males (p < 0.05). However, involvement of common iliac
artery with hemodynamic relevant atherosclerotic lesion was significantly
higher in males than females (p = 0.003).
Conclusions:
Clinical presentation, risk factors and anatomical distributions of
atherosclerosis among type-2 diabetic patients with symptomatic peripheral
arterial occlusive disease are different between males and females. When
compared to males, female patients presented more with critical limb
ischemia than intermittent claudication. Females showed higher age at
presentation, poor control of diabetes mellitus and higher level of high
density lipoprotein. Involvement of superficial femoral artery, deep femoral
artery and peroneal artery in hemodynamic relevant atherosclerotic lesion
were significantly higher in females than males. In contrast, common iliac
artery involvement with hemodynamic relevant atherosclerotic lesion was
significantly higher in males than females.