SEX DIFFERENCES IN PERIPHERAL ARTERIAL DISEASE: DIAGNOSIS, SYMPTOMS AND TREATMENT (Invited Lecture)
Judy Regensteiner, Ph.D., University of Colorado, School of Medicine, Aurora, CO, USA
Approximately 8-12 million people in the US have peripheral artery disease (PAD). Although it used to be thought that women were less likely to be diagnosed with PAD, in fact women now are estimated to comprise about half of this group. However, sex differences in diagnosis, symptoms and treatment of PAD are not well known and need to be better understood in order to lead to better treatment. In 2012, it was reported that women with PAD who were younger than 60 years of age were reported to have an increased risk for cardiovascular events in contrast to men younger than 60 (HR=4.9; 95% CI, 1.8-13.6), whereas no sex difference was seen above 60 years of age. In terms of risk factors for PAD, diabetes appears to be a more significant risk factor for claudication in women than men. Women with PAD are more likely to present without symptoms or with atypical symptoms. As a consequence, their vascular disease has been underdiagnosed and undertreated. Women with claudication also have worse quality of life than their male counterparts. With regard to treatments, exercise rehabilitation is more effective in men than women. Graft patency after revascularization is also worse in women than men with PAD. More research is needed to understand the sex differences that are just starting to be revealed. This is because better knowledge of these differences will hopefully result in the development of strategies to achieve sex-specific cardiovascular risk reduction and improvement in overall quality of life for women and men with PAD.