Gender Differences in the Medical Treatment of Peripheral Artery Disease

Abstract

Background/Objectives: Peripheral arterial disease is a frequent and severe disease with high cardiovascular morbidity and mortality. However, female patients appear to be undertreated. Objectives: The primary goal was to compare the prescription of optimal medical treatment (OMT) of peripheral arterial disease between women and men in primary health care. Material and methods: An observational retrospective study was based on the data collected from general practitioners (GP) office in Brittany. Results: The study included 100 patients, aged 71 ± 10 years old, with 24% of women. Compared to men, women received the OMT less frequently (29.2% vs. 53.9%, p = 0.038), especially after 75 years old. Antiplatelet therapy was largely prescribed (100%), statins less frequently (70.8% women vs. 85.5% men), and prescription of renin-angiotensin-aldosterone system inhibitors was still not optimal in the two genders (41.7% women vs. 61.9% men). Active smoking is important for both women and men (33% and 30% respectively). Conclusion: Optimal medical treatment of peripheral artery disease is insufficiently prescribed, especially in women in this region of France.

A hidden problem: peripheral artery disease in women

“… 13 , 18–20 Criqui and colleagues recently reported a lack of guideline adherence, with only ∼11–67% adherence observed for the use of evidence-based preventative therapies in PAD. 21 Women and older individuals have even lower rates of guideline-directed therapy, 22 , 23 and when given, the impact of therapies may be different with the sexes, e.g. antithrombotic therapies, 24 , 25 as described later.…”

Update on Management of Cardiovascular Diseases in Women

“…Furthermore, women have been less frequently referred for carotid endarterectomy, (CA), and heart transplantation (HT) than men with the same recognized indications [ 58 ]. Finally, in Peripheral Arterial Disease (PAD) women are less likely to receive appropriate therapy, especially in older age [ 246 ]. Women also receive fewer ICD than men [ 247 ].…”

“…ACS in Women STEMI: ↑30-day mortality ↑ Bleeding [244] After PCI: ↑Peri-procedural AMI ↑Major Bleeding ↑In-Hospital Mortality ↑2-years Mortality [208,244] Gp IIb/IIIa inhibitors: ↑Adverse effects ↓ Outcomes [208] Stable CAD in Women After elective PCI: Similar contemporary outcomes in both sex [208] Atrial Fibrillation and Stroke NOACs: ↑Effectiveness ↓ Bleeding Risk Warfarin in the correct TTR: No differences in CV mortality all-cause mortality and stroke risk between the sexes In stroke: Thrombolysis, antiplatelet and anticoagulant therapies ↑ beneficial Heart Failure With comparable treatment: ↑Clinical Outcomes [208,246].…”

“…Valsartan/Sacubitril: Equal beneficial effect [246] After CV procedures: ↑Morbidity ↑Mortality ↓ Health-related quality of life ↓ Functional improvement [58] Surgical, Interventional, and Electrophysiology Treatments TAVI: Beneficial in terms of short-, mid-, and long-term outcomes [243] ICD in women: ↑Device-related complications ↑Death ↑All-Cause readmissions ↑HF readmissions CRT: ↓ Mortality ↑Reverse remodeling of LV [183] Cardiac Rehabilitation ↑ Outcomes [255] Abbreviations: ACS: Acute Coronary Syndrome, STEMI: ST-Elevation Myocardial Infarction, PCI: Percutaneous Coronary Intervention, AMI: Acute Myocardial Infarction, Gp: Glycoprotein, NOACs: Novel Oral Anticoagulants, TTR: Target Therapeutic Range, CV: Cardiovascular, BBs: Beta-blockers, TAVI: Transcatheter Aortic Valve Implantation, ICD: implantable cardioverter-defibrillator, CRT: Cardiac resynchronization therapy, LV: Left Ventricle.…”

New insights on the cardiovascular effects of IGF-1

“…Coronary artery disease (CAD) is the most common comorbidity, and severe complications of this vascular pathology are heart attack, arrhythmias, chronic nephropathy, and ischemic stroke ( 2 , 3 ). Peripheral artery disease (PAD), also characterized by atherosclerotic plaque formation, manifests as lesions and pain in the lower extremities ( 4 , 5 ). Other heart and blood vessel disorders include deep vein thrombosis, pulmonary embolism, and rheumatic and congenital heart disease ( 1 , 6 , 7 ).…”