Gender‐Specific Risk Factors for Peripheral Artery Disease in a Voluntary Screening Population

Abstract

BackgroundWomen have high rates of peripheral artery disease (PAD) despite fewer cardiovascular disease (CVD) risk factors, compared to men. We sought to determine the gender‐specific prevalence of low ankle brachial index (ABI) and the relationship to C‐reactive protein (CRP) levels and CVD risk factors in the Life Line Screening population.Methods and ResultsBetween April 2005 and August 2011, 133 750 women and 71 996 men had ABI and CRP measured at a Life Line Screening Center. Women were slightly older than men, whereas men were more likely to be current smokers, have diabetes mellitus (DM), and coronary artery disease (CAD) (P<0.001 for each). Women were more likely to have ABI≤1.0, compared to men (26.6% versus 14.4%, respectively; P<0.001), as well as ABI≤0.9 (4.1% women versus 2.6% men; P<0.001). Women had higher median CRP levels (1.94 mg/L; interquartile range [IQR], 0.89, 4.44 mg/L), compared to men (1.35 mg/L; IQR, 0.73, 2.80 mg/L; P<0.001). Men and women shared similar risk factors for ABI≤0.9, including older age, black race, smoking, DM, hypertension, hypercholesterolemia, CAD, and elevated CRP levels. In an adjusted model, there were significant interactions between gender and age (P<0.001), CRP (P<0.001), CAD (P=0.03), and DM (P=0.06) with ABI as the outcome. The associations between age, CRP, CAD, and DM with ABI≤0.9 were stronger in men than in women.ConclusionsWomen participating in the Life Line Screening had higher CRP levels and a higher prevalence of PAD, compared to men. Neither higher CRP levels nor conventional CVD risk factors explained the excess prevalence of PAD in women.

Gender specific differences in peripheral artery disease and their impact on cardiovascular rehabilitation -the experience of a Romanian Rehabilitation Hospital

“…On the other hand, women had a lower ABI and higher median C-reactive protein levels compared to men [7]. Our research offered similar findings regarding smoking, but the women in our group were more exposed to having a history of diabetes mellitus compared to men, although it did not reach statistical significance.…”

Gender differences following supervised exercise therapy in patients with intermittent claudication

“…Besides, it accents the general problem of underrepresentation of women in clinical trials, 17 which is mainly due to current underdiagnoses of PAD in women caused by misleading clinical presentation and the contribution of alternative risk factors to cardiovascular diseases. 40 Last, we proposed several reasons to explain our results. However, motivation, pain tolerance, and differential use of medications (ie, statins or beta-blockers) were not assessed in this study and require further investigation.…”

Diabetes mellitus is a coronary heart disease risk equivalent for peripheral vascular disease

“…Diabetes severity was defined as: 1) diabetes without the use of either oral glucose-lowering agents or insulin; 2) diabetes with oral glucose-lowering agents only or 3) diabetes with use of insulin with or without use of oral glucose-lowering agents. Coronary heart disease was defined as a self-reported prior myocardial infarction or prior coronary revascularization (coronary artery bypass, angioplasty or percutaneous coronary intervention) (15). A diagnosis of hypertension was based on either a self-reported diagnosis of hypertension or the use of antihypertensive medications (15).…”