Peripheral Arterial Disease In Women Research Articles

Peripheral arterial disease in women.

Peripheral arterial disease (PAD) represents one of the most frequent manifestations of atherosclerosis in men and women. In both sexes, PAD is related to classical risk factors of atherosclerosis, which are similarly distributed, but some additional factors determine differences between men and women. More frequent asymptomatic disease in women than in men and less frequent screening in women may result in a false underestimation of the prevalence of PAD in women. All these factors may cause delayed diagnosis and treatment of PAD in women. Estrogen hormones have vasoprotective properties that lower the prevalence of atherosclerosis in women of younger age. However, estrogen probably does not have a protective role against the development of cardiovascular disease in women of an older age. Hormone replacement therapy (HRT) of less than one year does not appear to reduce the odds of developing PAD in postmenopausal women. It may even increase the risk of morbidity from vascular interventions. However, some studies indicated that HRT for more than one year significantly decreases the risk of PAD if administered early after the last menstruation. Also, treatment of PAD in women differs to some extent from men.

Smoking as a risk factor for lower extremity peripheral artery disease in women compared to men: A systematic review and meta-analysis.

To investigate whether the relationship between smoking and peripheral artery disease (PAD) differs by sex (PROSPERO CRD42022352318). PubMed, EMBASE, and CINAHL were searched (3 March 2024) for studies reporting associations between smoking and PAD in both sexes, at least adjusted for age. Data were pooled using random effects. Between-study heterogeneity was examined using I2 statistic and Cochran's Q test. Newcastle-Ottowa Scale was adopted for quality assessment. Four cohort studies (n = 2,117,860, 54.4% women) and thirteen cross-sectional studies (n = 230,436, 59.9% women) were included. In cohort studies, former and current smokers had higher risk of PAD than never smokers. Compared to those who never or previously smoked, women current smokers (relative risk (RR) 5.30 (95% confidence interval 3.17, 8.87)) had higher excess risk of PAD than men (RR 3.30 (2.46, 4.42)), women-to-men ratio of RR 1.45 (1.30, 1.62)(I2 = 0%, p = 0.328). In cross-sectional studies, risk of PAD was higher among former and current compared to never smokers, more so in men, women-to-men ratios of odds ratio: 0.64 (0.46, 0.90)(I2 = 30%, p = 0.192), 0.63 (0.50, 0.79)(I2 = 0%, p = 0.594), respectively. For both sexes, risk of PAD was higher among current smokers compared to those who were not currently smoking. Cohort studies and five cross-sectional studies were of good quality, scoring 6 to 8 of a possible maximum 9 points. Eight cross-sectional studies scored 2 to 5. Further research is required to elucidate sex differences in the relationships between smoking and PAD, as the current evidence is limited and mixed. Tobacco-control programs should consider both sexes.

Peripheral Arterial Disease in Diabetes and its Relation to Cardiovascular Risk Factors in Women

Objectives: Peripheral arterial disease (PAD) is characterized by occlusive disease in the abdominal aorta, iliac, and femoral arteries, leading to reduced blood flow and complications. Diabetes mellitus (DM) is known to contribute to the development and progression of PAD due to factors such as hyperglycemia, dyslipidemia, endothelial dysfunction, and inflammation. However, PAD may be underdiagnosed in women with DM, leading to adverse cardiovascular outcomes. The present study aimed to investigate the prevalence of PAD in women with type 2 DM (T2DM) and its relationship with cardiovascular risk factors. Materials and Methods: This hospital-based, cross-sectional, and observational study was conducted for a period of 3 months from June 10, 2023, to September 10, 2023, in the outpatient department of general medicine. After obtaining the approval from the Institutional Ethical Committee, the study was performed according to the Declarations of Helsinki and Good Clinical Practice requirements for human subject protection. Non-probability purposive sampling technique was used to enroll participants. Participants underwent face-to-face interviews and clinical examinations. Sociodemographic data, medical history, and pharmacotherapy details were collected. Laboratory investigations were conducted, including blood glucose, lipid profile, and glycosylated hemoglobin (HbA1C) tests. The ankle-brachial index (ABI) was measured. Results: The results showed that the majority of the participants were between 50 and 70 years of age, married, and had a high school education. Participants had an average body mass index (BMI) indicating overweight, and the average duration of diabetes was 6.571 years. Hypertension was the most prevalent comorbidity. Overweight, obesity I, and obesity II were present in 15.25% (n = 19), 33.6% (n = 42), and 8.8% (n = 11), respectively. Average values for HbA1C, fasting blood glucose (FBG), and postprandial blood glucose (PPBG) were within the diabetic range. ABI was normal in the right side, left side, and bilateral in 43.2%, 56%, and 14.4% of participants, respectively. ABI was borderline on the right side, left side, and bilateral in 40.8%, 36.8%, and 22.4% of participants, respectively. PAD was observed on the right side, left side, and bilateral in 16%, 7.2%, and 4% of participants, respectively. BMI, duration of DM, glycosylated hemoglobin, FBG, and PPBG showed significant negative correlations with ABI. Age, triglycerides, high-density lipoprotein, and low-density lipoprotein did not show any statistically significant correlation with ABI. Conclusion: The study highlighted the importance of screening for PAD in women with T2DM to improve cardiovascular outcomes. The findings shed light on the prevalence of risk factors for PAD and their association with the disease. These insights can contribute to the development of targeted interventions to reduce adverse clinical outcomes in this population.

Sex differences in risk factors for incident peripheral artery disease hospitalisation or death: Cohort study of UK Biobank participants.

Women with peripheral artery disease (PAD) often have atypical symptoms, late hospital presentations, and worse prognosis. Risk factor identification and management are important. We assessed sex differences in associations of risk factors with PAD. 500,207 UK Biobank participants (54.5% women, mean age 56.5 years) without prior hospitalisation of PAD at baseline were included. Examined risk factors included blood pressure, smoking, diabetes, lipids, adiposity, history of stroke or myocardial infarction (MI), socioeconomic status, kidney function, C-reactive protein, and alcohol consumption. Poisson and Cox regressions were used to estimate sex-specific incidence of PAD hospitalisation or death, hazard ratios (HRs), and women-to-men ratios of HRs (RHR) with confidence intervals (CIs). Over a median of 12.6 years, 2658 women and 5002 men had a documented PAD. Age-adjusted incidence rates were higher in men. Most risk factors were associated with a higher risk of PAD in both sexes. Compared with men, women who were smokers or had a history of stroke or MI had a greater excess risk of PAD (relative to those who never smoked or had no history of stroke or MI): RHR 1.18 (95%CI 1.04, 1.34), 1.26 (1.02, 1.55), and 1.50 (1.25, 1.81), respectively. Higher high-density lipoprotein cholesterol (HDL-C) was more strongly associated with a lower risk of PAD in women than men, RHR 0.81 (0.68, 0.96). Compared to HDL-C at 40 to 60 mg/dL, the lowest level of HDL-C (≤40 mg/dL) was related to greater excess risk in women, RHR 1.20 (1.02, 1.41), whereas the highest level of HDL-C (>80 mg/dL) was associated with lower risk of PAD in women, but higher risk in men, RHR 0.50 (0.38, 0.65). While the incidence of PAD was higher in men, smoking and a history of stroke or MI were more strongly associated with a higher risk of PAD in women than men. HDL-C was more strongly associated with a lower risk of PAD in women than men.

Women take longuer to seek help when suffering a STEMI

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Historically, the prognosis of those women suffering a STelevation myocardial infarction (STEMI), has been worse compared to men. Some causal factors are presentation at later ages, atypical symptoms, lower perception of risk and less sensitivity of the health care providers. Purpose Our hypothesis is that there are still differences in the presentation of STEMI based on gender, which could be identified to guide new public campaigns in this perspective. Therefore our primary outcome is to find gender differences in symptoms and time delays in a cohort of STEMI patients, and secondary outcomes are differences in mortality and bleeding. Methods We conducted a retrospective analysis carried out in the Acute Cardiac Care Unit (ACCU) of a tertiary care hospital, where 50% of the medical staff are women. Patients hospitalized for STEMI for one year were included and a detailed caracterization of symptoms, time delays, and adverse events was recorded. Finally, the patients were classified according to gender, and differences in primary and secondary outcomes between both groups were analyzed. Results Between May/2020 and May/2021, 1056 patients were admitted to the ACCU, 33% were women. A total of 115 STEMI patients were included for the analysis, 21% were women. Basal characteristics of both groups were equivalent, except for a non significand trens towards less prevalence of peripheral arterial disease in women (0% vs. 11%; OR 0.890, IC 95% 0.828-0.957; p=0.089). Opressive chest pain was the most frequent symptom, but it was less frequent in women (75% vs. 91.4%, OR 0.284, IC 95% 0.085-0.948; p=0.033), whereas they presented more frequently with stabbing pain (13% vs. 2.4%, OR 6, IC 95% 1.073-38.35; p=0.035), and their pain was more frequently radiated towards the neck (28.6% vs. 4.9%, OR 7.7, IC 95% 1.1936-30.631; p=0.001), and associated to nausea/vomiting (45% vs. 1.3%, OR 5.809, IC 95% 1.930-17.486; p=0.001). There was a non-significant trend towards a longer time delay between pain onset and seek for help in women (185min IQR 747 vs. 60min IQR 454, p=0.098), being the other system time delays equivalent between both gender groups. Women had an increased bleeding risk, with a higher CRUSADE score (47.48 ± 22.92 vs. 28.60 ± 16.72, p=0.001) and higher incidence of bleeding events (12.55% vs. 0%, OR 11.68, IC 95% 9.82-13.29, p=0.001). There were no differences in the treatments administered or in mortality (12.5% vs. 14.3%, p=0.822). Conclusions Women suffering a STEMI more often reported stabbing chest pain, radiating to the neck, and associated to nausea/vomiting compared with men, and took longer to seek for help. These findings could help in the design of future campaigns to minimize time delays, targeting these different symptoms in female population.

Characteristics of Peripheral Arterial Disease in Women

Objective: Peripheral arterial disease (PAD) affects more than 200 million people.1 With an estimated prevalence of 3 – 29% in women.2 Asymptomatic PAD is more common in women than in men.3 However, when symptomatic, women have a more complex and severe disease, affecting several arterial sectors (with chronic limb threatening ischaemia, CLTI) and with worse outcomes.3–6 Women present with symptoms, on average, 10 – 20 years later than men.4 There has been a low representation of women in PAD studies and clinical trials.7 This study aims to characterise PAD in hospitalised women. It is an objective to compare the cardiovascular risk factors, clinical presentation, therapeutic strategies, and outcomes between women and men.

The Link Between Reproductive History, Cardiovascular Disease, and Peripheral Arterial Disease in Women: Implications for Practice

The average life expectancy in the United States fell for the second straight year. Attributed mostly to COVID-19 and unintentional injuries (driven by drug overdoses), the third most prevalent cause of death is heart disease. Peripheral arterial disease (PAD) is an often-unrecognized global pandemic affecting more than 220 million. Since early 2000, the incidence of PAD has increased by 25% globally, Once considered a male-dominated disease, PAD is a significant cause of morbidity and mortality among women. This article provides a comprehensive review of the sex-linked risk factors for PAD that pose additional threats for women. Implications for practice are provided.

Peripheral Arterial Disease in Women: The Effects of Smoking and Environmental Tobacco Smoke

Peripheral Arterial Disease in Women: The Effects of Smoking and Environmental Tobacco Smoke

Objective Coagulation Profiling Provides Novel Insight into Potential Risk Factors for Peripheral Artery Disease in Women

The prevalence and burden of peripheral artery disease (PAD) is equal, if not higher, in women as compared with men, and it is known that clinical outcomes in women after revascularization procedures are worse. However, women are notably under-represented in existing PAD studies, contributing to a significant gap in clinical knowledge regarding the risk factors and nature history of female-specific disease. Traditional comorbidities associated with cardiovascular disease and PAD are more prevalent in men than women, suggesting that alternative etiologies may be contributing to atherosclerosis in female patients. Thromboelastography with platelet mapping (TEG-PM) measures the viscoelastic properties of a blood clot as a dynamic process and may provide an integral key to the next stage of patient-centered hypercoaguability assessment. This prospective observational study aimed to characterize the clinical and TEG-PM profiles of female and male patients prior to lower extremity revascularization procedures. All patients undergoing named vessel revascularization during December 2020 to December 2021 at a large tertiary institution were prospectively included. TEG-PM assays were performed on patients prior to surgery. These data, along with clinical metrics, were compared between men and women. Univariate analysis was performed using the Student t test for continuous variables and the Fisher exact test for binary variables. One hundred twenty-one patients were enrolled, of which 40 (39.6%) were female. Female patients had significantly lower rates of hypertension (62.5% vs 88.9%; P < .01) and diabetes (25.0% vs 54.3%; P < .01) as compared with men. There were no significant differences in age at time of enrollment, body mass index, smoking status, or hyperlipidemia between groups (Table I). TEG-PM data demonstrated significantly higher levels of platelet aggregation in female patients compared with male patients (62.8 ± 36.6 vs 43.6 ± 34.9; P = .03) and significantly lower levels of platelet inhibition in female patients (37.2 ± 36.6 vs 56.4 ± 34.9; P = .03) (Fig 1). There was no significant difference in the use of monoantiplatet therapy (62.5% vs 61.7%; P = 1.00), dual antiplatelet therapy (22.5% vs 38.2%; P = 1.00), or anticoagulation (30.0% vs 46.9%; P = .08) between groups (Table I). In this preoperative cohort, we found traditional PAD risk factors, such as hypertension and diabetes, to be significantly higher in men compared with women. Viscoelastic data, however, showed significantly greater platelet reactivity in women compared with men. This important insight demonstrates that the prevailing paradigm of risk stratification and disease modification may not fit the female population with PAD, and provides an important basis for further research into gender-specific coagulation profiles.TableClinical and thromboelastography with platelet mapping metrics between female and male patients with peripheral arterial diseaseFemaleMean (SD) or No.(%)MaleMean (SD) or No.(%)PTotal patients4081Clinical factors Age, y69.1 (±11.7)67.4 (±10.2).50 BMI, kg/m226.8 (±8.9)27.5 (±4.9).65 Ever smoker19 (46.3)36 (44.4).85 HTN25 (62.5)72 (88.9)<.01 HLD27 (67.5)44 (54.3).18 DM10 (25.0)44 (54.3)<.01TEG values R time6.5 (±2.6)6.5 (±3.0).94 K time2.0 (±1.5)1.8 (±1.2).50 α-angle66.9 (±10.0)69.3 (±12.2).33 MA57.6 (±8.1)60.8 (±8.5).46Platelet mapping values % Platelet aggregation62.8 (±36.6)43.6 (±34.9).03 % Platelet inhibition37.2 (±36.6)56.4 (±34.9).03Anthrombotic therapy MAPT25 (62.5)50 (61.7)1.00 DAPT9 (22.5)31 (38.2)1.00 Full-dose AC12 (30.0)38 (46.9).08AC, Anticoagulation; BMI, body mass index; DAPT, dual antiplatelet therapy; DM, diabetes mellitus; HLD, hyperlipidemia; HTN, hypertension; MAPT, mono antiplatelet therapy; SD, standard deviation; TEG, thromboelastography.Boldface P indicates statistical significance. Open table in a new tab

Sex-Specific Differences in Cardiovascular Risk, Risk Factors and Risk Management in the Peripheral Arterial Disease Population.

Cardiovascular disease (CVD) is the leading cause of mortality in women worldwide but has been primarily recognised as a man’s disease. The major components of CVD are ischaemic heart disease (IHD), stroke and peripheral arterial disease (PAD). Compared with IHD or stroke, individuals with PAD are at significantly greater risk of major cardiovascular events. Despite this, they are less likely to receive preventative treatment than those with IHD. Women are at least as affected by PAD as men, but major sex-specific knowledge gaps exist in the understanding of relevant CVD risk factors and efficacy of treatment. This prompted the American Heart Association to issue a “call to action” for PAD in women, in 2012. Despite this, PAD and CVD risk in women continues to be under-recognised, leading to a loss of opportunity to moderate and prevent CVD morbidity. This review outlines current evidence regarding cardiovascular risk in women and men with PAD, the relative significance of traditional and non-traditional risk factors and sex differences in cardiovascular risk management.

"SHE" is at Risk: Analysis of Clinical Profiles, Interventions and Outcomes of Peripheral Arterial Disease in Women over a Period of 15 Years from India

Background: Peripheral arterial disease (PAD) is gaining equal status like Coronary artery disease (CAD) and Cerebrovascular accident (CVA) worldwide in terms of morbidity, economic issues and mortality. Females with PAD exhibit more of asymptomatic/ subclinical disease pattern. Any gender-based differences in terms of clinical profiles and treatment outcomes of PAD is crucial to be studied. Our study is a first of its kind in Indian subcontinent analysing only female PAD patients. Objective: The purpose of this article is to assess the risk factor profiles, natural course of the disease, varied treatment options and their outcomes in different age groups of female PAD population coming to our centre. Methods: This is a retrospective study and included all female patients who were diagnosed with PAD between the age group of 25 to 90 years and either underwent Vascular intervention or had conservative treatment for the same at Ramaiah medical college hospital, Bangalore, over a period of 15 years from 2004 to 2018. Results: The mean age of all cases was 59.41 years. Most common risk factors were “diabetes mellitus” (54.6%), “hypertension” (42.9%) and obesity (35.9%). Aorto Iliac segment interventions were done in 27 cases, SFA & popliteal in 195 cases and infra-popliteal in 81 cases. Technical success rate of open procedures was 96 % and for endovascular 90%. Major complications encountered were groin infection, hematoma, nephropathy and distal embolization. In a follow-up of 1 year, 48 patients succumbed to death due to coronary event and 66 of them required re-intervention due to either bypass graft thrombosis or new tissue loss. Conclusion: PAD in females remains a major healthcare problem in our community, often due to delayed presentation and self-neglect, which leads to financial burden, increased risk of coronary or limb related adverse events and mortality in this population.

Abstract 15937: Gender Disparities in Presentation and Outcomes for Patients Undergoing Endovascular Lower Extremity Interventions for Peripheral Artery Disease

Introduction: Although data suggests higher rates of functional decline and inferior outcomes in women compared to men after interventions for peripheral artery disease (PAD), women remain underrepresented in contemporary studies. We used a large national database to better understand gender-based differences in presentation and outcomes for patients undergoing endovascular treatment for PAD. Methods: Patients in the Vascular Quality Initiative (VQI) database that underwent lower extremity (LE) endovascular interventions for symptomatic PAD from 2010-2019 were included. Descriptive statistics and multivariable analysis were performed. Results: 128,688 patients (40% female) underwent endovascular LE interventions for symptomatic PAD. Women were more likely to have chronic limb threatening ischemia compared to men (54% vs 51%) and more likely to have a preoperative ABI &lt;0.4 (20% vs 14%). Compared to men, women were older (mean [SD]: 68 [11] vs 70 [12]), more likely to be Black (19% vs 14%), and less likely to be smokers (34% vs 36%), diabetic (50% vs 54%), have CAD (28% vs 35%), or be on dialysis (8% vs 9%) (Table 1). Women were less likely to have exclusively infrapopliteal interventions (8% vs 14%) compared to men (p&lt;0.001 for all). Despite shorter procedural times in women, female gender was an independent predictor of in hospital mortality (OR 1.25, 95% CI 1.09-1.44) in a hierarchical multivariable model adjusting for age, race, smoking, and comorbidities. Women were more likely to be discharged to a rehab or nursing home (11% vs 10%, p&lt; 0.001) and less likely to be taking a statin medication (73% vs 78%, p&lt;0.001). Conclusions: Compared to men, women undergoing endovascular LE interventions for PAD are older, present with more severe disease, and have higher adjusted rates of in hospital mortality. More aggressive screening and medical treatment for PAD in women is needed to address these gender-based differences in disease presentation and clinical outcomes.

Dietary Pattern Indices and Incident Peripheral Arterial Disease in Women: A Prospective Cohort Study

Abstract Objectives We aimed to evaluate diet quality as reflected by multiple a priori dietary pattern indices in relation to incident PAD. Methods We included 138,506 US postmenopausal women aged 50–79 years without known PAD at baseline (1993–1998) of the Women's Health Initiative. Score of 4 dietary pattern indices, including the alternate Mediterranean diet (aMED) index, the alternate Healthy Eating Index (AHEI)-2010, the Dietary Approaches to Stop Hypertension (DASH) diet index, and the Healthy Eating Index (HEI)-2015, were derived using data collected by a validated food frequency questionnaire. Incident cases of symptomatic PAD in the lower extremities were ascertained and adjudicated through March 2019 by reviewing medical record. Hazard ratios (HR) and 95% confidence interval (CI) were estimated using Cox proportional hazards models, with adjustment for multiple potential confounders including known risk factors for PAD (i.e., smoking, high blood pressure, dyslipidemia, and diabetes). Results During a median 18.6 years of follow-up, 1036 incident cases of PAD were identified. All 4 dietary pattern indices were inversely associated with risk of PAD. The multivariable-adjusted HRs (95% CI) comparing the highest with the lowest score quartiles were 0.74 (0.61–0.91) for aMED index (P-trend across quartile = 0.010), 0.79 (0.65–0.95) for AHEI-2010 (P-trend &amp;lt; 0.001), 0.66 (0.55–0.80) for DASH index (P-trend &amp;lt; 0.001), and 0.68 (0.56–0.82) for HEI-2015 (P-trend &amp;lt; 0.001). Among major foods/nutrients contributing to these dietary patterns, intakes of whole grains (top vs. bottom quartile, HR = 0.81; P-trend = 0.01), legumes (HR = 0.77; P-trend = 0.004), dietary fiber (HR = 0.78; P-trend = 0.01), and vegetable protein (HR = 0.76; P-trend = 0.006) were associated with lower risk of PAD, whereas intakes of red meat (HR = 1.38; P-trend = 0.003), processed meat (HR = 1.36; P-trend = 0.004), and regular soft drinks (HR = 1.26; P-trend = 0.01) were associated with higher risk. Conclusions Adherence to various recommended dietary patterns is associated with lower risk of PAD in a nationwide cohort of US postmenopausal women. Our findings may extend the range of cardiovascular diseases that are potentially preventable by adopting a healthy dietary pattern. Funding Sources National Heart, Lung, and Blood Institute; and National Institute of Diabetes and Digestive and Kidney Diseases.

Peripheral artery disease in women

Peripheral artery disease (PAD) is a common disease among women and is expected to increase in the coming years. Diagnostic and therapeutic management of PAD in women is difficult due to their gender-related differences, comorbid factors, atypical symptoms, more functional disorders, the presence of advanced disease, being older age of the disease onset, smaller vessel diameter, and psychosocial factors. Especially due to the high prevalence of asymptomatic disease, late admission status and further disease on admission affect the success of the treatment negatively. By focusing more on PAD in women and more clinical studies, gender-specific differences can be identified. Hereby, there is a need to develop appropriate strategies to improve women's overall quality of life. In this review, we aimed to draw attention to the female gender with PAD, which is increasingly occurring.

Peripheral Arterial Disease Prevention in Women: Awareness and Action.

Peripheral Arterial Disease Prevention in Women: Awareness and Action.

Contributions of HIV, hepatitis C virus, and traditional vascular risk factors to peripheral artery disease in women.

HIV and hepatitis C virus (HCV) have been associated with cardiovascular disease (CVD), but it is unclear whether HIV and HCV are also associated with peripheral artery disease (PAD). We examined the association of HIV, HCV, and traditional CVD risk factors with PAD in the Women's Interagency HIV Study, a multicenter US cohort. In this cross-sectional study, ankle-brachial index was estimated using Doppler ultrasound and manual sphygmomanometer in 1899 participants aged more than 40 years with HIV/HCV coinfection, HCV or HIV monoinfection, or neither infection. Multivariable logistic regression was used to estimate the odds of PAD (ankle-brachial index ≤0.9) after controlling for demographic, behavioral, and CVD risk factors. Over two-thirds were African-American, median age was 50 years, and PAD prevalence was 7.7% with little difference by infection status. After multivariable adjustment, neither HIV nor HCV infection was associated with greater odds of PAD. Factors associated with PAD included older age [adjusted odds ratio (aOR): 2.01 for age 61-70 vs. 40-50 years; 95% confidence interval (CI): 1.04, 3.87], Black race (aOR: 2.30; 95% CI: 1.15, 4.63), smoking (aOR: 1.27 per 10-pack-year increment; 95% CI: 1.09, 1.48), and higher SBP (aOR: 1.14 per 10 mmHg; 95% CI: 1.01, 1.28). The high PAD prevalence in this nationally representative cohort of women with or at risk for HIV is on par with general population studies in individuals a decade older than our study's median age. HIV and HCV infection are not associated with greater PAD risk relative to uninfected women with similar risk factors. Modifiable traditional CVD risk factors may be important early intervention targets in women with and at risk for HIV.

Peripheral Arterial Disease in Women: The Gender Effect.

Peripheral arterial disease (PAD) is a common atherosclerotic disease approximately affecting 8.5 million Americans above age 40 and is associated with significant functional impairment, morbidity and mortality from both cardiovascular and non-cardiovascular causes. PAD has increasing prevalence in females contrary to previous findings. Compared to men, women with PAD are more asymptomatic or have atypical symptoms. Women with PAD have increased quality of life impairment, increased risk of depression and increased cardiovascular mortality. The intent of this review is to provide an update on gender differences in PAD that can help in timely diagnosis and appropriate management through intensive cardiovascular risk factor modification, exercise program and guideline directed therapy to improve cardiovascular outcomes.

Identifying and managing younger women at high risk of cardiovascular disease.

KEY POINTS Cardiovascular disease (CVD), which is largely preventable, is a leading cause of morbidity and mortality among Canadian women. For this article, we use CVD to refer to ischemic heart disease and stroke. Data for peripheral arterial disease in women are limited and are addressed elsewhere

Ankle-Brachial Index as a Predictor for Cardiovascular Disease in Postmenopausal Women

Abstract Background and Aim Menopausal women are at an increasing risk of cardiovascular diseases due to ovarian failure with estrogen deficiency. Redistribution of fat leading to abdominal obesity is a risk factor for cardiovascular disease. Dyslipidemia is one of the risk factors for peripheral artery disease (PAD) and coronary artery disease (CAD). Prevalence of PAD in women is similar or even higher than men, especially after menopause. ankle-brachial index (ABI) is a gold standard technique to diagnose PAD and acts as an independent prognostic marker to identify patients with high cardiovascular risk. This study aims to compare the ABI between pre- and postmenopausal women and to show that routine use of ABI as a screening tool can be valuable in predicting mortality and morbidity from heart diseases in peri- and postmenopausal women. Material and Methods A cross-sectional study was done on a total of 107 women with no prior medical diseases such as hypertension, diabetes mellitus, cardiovascular diseases, and history of smoking. Fifty pre- and 57 postmenopausal women were included in this study. Anthropometric parameters such as height, weight, and body mass index (BMI) were measured. ABI was calculated by measuring the systolic pressures at posterior tibial artery and brachial artery, as per the protocols using digital data acquisition system. Results BMI in postmenopausal women was significantly higher with p = 0.0023. Systolic and diastolic blood pressures were significantly higher in postmenopausal women (p = 0.000001), and ABI was found to be significantly lower in postmenopausal women particularly on the left side. Conclusion ABI serves as an efficient indicator of PAD. It becomes necessary to understand the progression of PAD as its presence can increase the risk of mortality and morbidity from CAD. Early diagnosis of cardiovascular disease through simple techniques such as ABI measurement would provide scope for early interventional strategies.

Report on a Program to Improve Vascular Care for Women: Experience in 68,402 Patients Seen in Primary Care Clinics

Background: Lower extremity peripheral artery disease (PAD) affects at least 8.5 million people nationwide, causing 143,000+ hospitalizations and 40,000 amputations annually. Women with PAD have a higher chance of being asymptomatic or present with atypical symptoms. Fewer than half of affected women know they have PAD, and studies illustrate an expected increase in under-diagnoses in these women. Women with PAD are two to three times more likely to experience stroke or myocardial infarction (MI). This is the first report on the clinical feasibility of using a specialized volume plethysmography system (VPS) as operated by a medical aide in the primary care setting to perform PAD testing on female patients. Methods: In 2018, consecutive female patients in primary care settings were evaluated for the presence or absence and severity of PAD. Beforehand, the patients completed a self-administered questionnaire to identify gender, age, PAD symptoms, and atypical cardiovascular factors. Medical aides performed the test as part of routine clinical practice and presented results to primary care physicians who made the diagnosis based upon test findings. Results: Of the 68,402 patients who met the American Heart Association/American College of Cardiology criteria and were tested in the primary care setting, 26,576 or 38.9% had moderate to severe PAD. These patients were frequently asymptomatic, hypertensive, hyperlipidemic, diabetic, and/or had a history of tobacco smoking. Conclusion: VPS is an accurate, reproducible, cost-effective, and clinically feasible in-office or home visit test allowing for detection of PAD in women earlier in the disease process.