Women With Peripheral Arterial Disease Experience Faster Functional Decline Than Men With Peripheral Arterial Disease

Study Questions:

Do gender-related differences in functional decline among patients with peripheral arterial disease (PAD) exist?


This study included men and women, over the age of 58 years with documented PAD, who completed a 6-minute walk test. PAD was defined as having an ankle-brachial index <0.90. Additional assessments of mobility disability and 4 m walking velocity were also obtained. Each subject had received a computed tomography-assessed calf muscle characteristic at baseline and annually thereafter for up to 4 years. The primary outcomes of interest included becoming unable to walk for 6 minutes continuously (among those who could walk for that time at baseline). Additional outcomes included mobility loss ,defined as becoming unable to walk for a quarter mile or inability to walk up and down one flight of stairs without assistance. Results were adjusted for age, race, body mass index, physical activity, the ankle-brachial index, comorbidities, and other confounders.


A total of 380 subjects were included in this analysis. The mean age of women participants was 76 years; the mean age of the men was 74 years. Women with PAD were more likely to be African American and to have arthritis of the knees or disc disease. Women were less likely to have angina, as compared to the men with PAD. After adjusting for age, women walked fewer blocks per week, and did not perform as well on the 6-minute walk test, as compared to men. Women had smaller calf muscle area, lower calf muscle density, and weaker knee extension strength compared with the men. At 4 years of follow-up, women were more likely to become unable to walk for 6 minutes continuously (hazard ratio [HR], 2.32; 95% confidence interval [CI], 1.31-4.11; p < 0.004), and more likely to develop mobility disability (HR, 1.88; 95% CI, 1.10-3.20; p < 0.021) compared to the men. Women also had faster declines in walking velocity (p < 0.03) and the distance achieved in the 6-minute walk (p < 0.04) compared with men. Sex differences in functional decline were attenuated after additional adjustment for baseline sex differences in calf muscle area.


The authors concluded that women with PAD were observed to have faster functional decline and greater mobility loss compared to men with PAD. These gender differences may be attributable to smaller baseline calf muscle area among women.


The study highlights important gender differences among patients with PAD. Such information can be used to develop treatment strategies that may assist female patients with PAD.

Related Story:
CardioSmart: Clogged Leg Arteries Hinder Walking More in Women than Men

Clinical Topics: Diabetes and Cardiometabolic Disease, Prevention, Vascular Medicine, Atherosclerotic Disease (CAD/PAD), Exercise

Keywords: Walking, Follow-Up Studies, Knee Joint, Peripheral Arterial Disease, Leg, United States

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