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Women respond less well to treatment for peripheral artery disease (PAD) and have worse clinical outcomes, according to new research.
The study, published in the European Heart Journal, found that there are complex interacting factors, including biological, clinical, and societal variables, that need to be considered for strategies to improve gender-related needs in PAD healthcare.
Biological factors include women having a higher risk of blood clots (a cause of PAD) and smaller blood vessels, while oral contraceptives and pregnancy complications have been linked with higher PAD rates.
Clinical factors refer to how patients engage with healthcare services, their relationships with physicians, and the processes in place to diagnose and treat PAD. The paper cites low awareness of the risk of PAD in females among healthcare providers and women themselves.
Health staff are also less likely to recognise PAD in women compared to men, and women are more likely than men to be misdiagnosed with other conditions including musculoskeletal disorders.
“Greater understanding is needed about why we are failing to address the health outcome gap between genders,” said author Mary Kavurma, an associate professor at the Heart Research Institute, Australia. “This review encompasses not just biological reasons but also how healthcare services and women’s part in society may play a role. All of these elements should be taken into account so that more effective methods of diagnosis and treatment can be targeted at women with peripheral artery disease.”
What is peripheral artery disease?
More than 200 million people worldwide have PAD, where arteries in the legs are clogged, restricting blood flow and raising the risk of heart attack and stroke. PAD is the leading cause of lower limb amputation. Evidence suggests that equal or greater numbers of women have the condition, and that they have worse outcomes.
Peripheral artery disease is classified into three phases: asymptomatic, typical symptoms of pain and cramping in the legs when walking that are relieved at rest (called intermittent claudication) and chronic limb-threatening ischaemia (CLTI) which is the most severe stage and can include gangrene or ulcers.
Women often have no symptoms or atypical ones such as minor pain or discomfort while walking or at rest. They are less likely than men to have intermittent claudication and twice as likely to present with CLTI. Hormones appear to play a role, as women tend to show typical symptoms (intermittent claudication) post-menopause. The ankle brachial index, which compares blood pressure in the upper and lower limbs, is used for diagnosis but is less accurate in those with no symptoms or smaller calf muscles.
Treatment of PAD includes medication, exercise and surgery. It aims to manage symptoms and reduce the risks of ulceration, amputation, heart attack and stroke. Women are less likely to receive recommended medications than men and respond less well to supervised exercise therapy. Women have lower rates of surgery and are more likely to die after amputation or open surgery than men.
Co-author Associate Professor Sarah Aitken, a vascular surgeon and Head of Surgery at the University of Sydney, added: “Whilst we are working on encouraging women to train as vascular surgeons, the current shortfall means that female patients are unlikely to see a surgeon of the same gender, and research, publications and policies may not fully represent the perspectives of women.”