Sex Differences in the Ankle Brachial Index Measurement and Interpreting Findings of Sex Differences in Peripheral Artery Disease Burden.

Abstract

In 2012, the American Heart Association published a Call to Action encouraging scientific investigation of the prevalence and significance of lower extremity peripheral artery disease (PAD) in women.1 Noting a paucity of high-quality research on PAD in women, the statement called for more population-based evidence on the sex and age-specific prevalence and incidence of PAD. Article, see p S86 In this issue of Circulation: Cardiovascular Quality and Outcomes , Wang et al2 address this knowledge gap by studying sex differences in the incidence of PAD in chronic kidney disease. Wang et al2 report a higher incidence of PAD in women than in men participating in the Chronic Renal Insufficiency Cohort (CRIC), an observational longitudinal study of people aged 21 to 74 years with mild to moderate chronic kidney disease. Wang et al2 followed up 3174 CRIC participants (1427 [45%] women; mean age, 56.6 years) who had an ankle brachial index (ABI) ≥0.90 and no clinically evident PAD at baseline. New PAD during follow-up was defined as the occurrence of one of the following: ABI <0.90, lower extremity revascularization, or amputation. At a median follow-up of 5.9 years, the incidence of newly diagnosed PAD was 323 of 1427 (22.6%) in women versus 242 of 1747 (13.8%) in men ( P <0.001). This sex difference in PAD incidence was because of a higher incidence of ABI <0.90 among women than among men (310/1427 [21.7%] versus 220/1747 [12.6%]; P <0.001). In contrast, there was no difference in the incidence of lower extremity revascularization or amputation between men and women (13/1427 [0.9%] versus 22/1747 [1.3%]; P =0.33). Contrary to these findings, previous epidemiologic studies of people without chronic kidney disease showed no sex differences in the incidence of PAD.3–5 For example, in the Multi-Ethnic Study of Atherosclerosis (MESA), …