Women and Peripheral Arterial Disease
April 13, 2018 | Erica Flores, MD
The ACC, along with the rest of the nation, recently recognized women’s heart disease throughout the entire month February. Therefore, it is appropriate to focus on where we are today with women and peripheral arterial disease (PAD).Just as there was low awareness of coronary artery disease (CAD) in the female population, there is currently a low awareness regarding PAD. CAD awareness was increased with the “Go Red for Women” movement, and it is time to start a similar campaign for PAD.
Raising awareness about this topic is important because women diagnosed with PAD have greater functional impairment compared to their male counterparts at similar walking distances. In the past, studies have also shown that despite their greater functional impairment, women were less likely to undergo revascularization. Is the reason because they were already too far along in the disease course or their symptoms were not recognized? The answer is unclear. Currently, results from more recent studies are mixed as to whether this fact still remains true. Asymptomatic PAD and atypical leg symptoms are seen in both men and women, but are seen in women to a greater extent. This finding likely translates to women being diagnosed later on into the disease course, and thus the severity of disease is more advanced by the time they are diagnosed.
Some studies have also shown a more rapid functional decline in women with PAD compared to female counterparts without PAD. It is evident that the burden of disease is high in women, as studies show that women attend as many or more PAD physician visits as men. Our goal as cardiologists is to prevent loss of functional capacity, amputation rates and ischemic events. All of these factors point out the reason we need to increase the rate women are identified with or at risk for PAD.
Another factor is that women are currently underrepresented in clinical trials, although this area is improving with trials starting to include women more often. Given the fact that the female gender is identified as a perioperative risk factor, it is necessary to further study this population since high-risk patients have worse outcomes with surgical vs. endovascular repair. Cardiologist need to continue being aware of this issue so that there is equal representation for men and women, especially given the fact that guidelines are based on the results of these trials.
So, how do we go about educating women and heightening awareness regarding PAD? Studies show that women are more likely to obtain primary care than men, and will either see a primary care provider or an obstetrics/gynecologist on a regular basis. Therefore, it is important to engage primary care physicians in regard to screening and referral for further evaluation of PAD.
Screening should be done in all patients who are at high risk of PAD, along with those who have symptoms, abnormal lower extremity pulses, history of coronary or cerebrovascular disease and diabetes mellitus. There are various fliers or posters with these screening recommendations that can be posted in the office of the primary care providers to remind providers and inform patients. PAD information can also be incorporated into the community meetings with women regarding CAD. We need to come together in order to determine any other barriers to promoting PAD awareness. For now, my plan is to educate primary care physicians and translate the "Go Red for Women" campaign into one for PAD.
This article was authored by Erica Flores, MD.