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Sex related differences in therapy and outcome of patients with intermittent claudication in a real-world cohort
L Makowski1, J Feld2, J Köppe2
1Dept. of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Cardiol., Muenster, Germany.
Insights
Male patients with intermittent claudication (IC) have worse cardiovascular risk profiles and higher mortality. Despite lower treatment rates for women, men face greater risks for long-term mortality and chronic limb-threatening ischemia (CLTI).
Area of Science:
- Vascular Surgery
- Cardiology
- Epidemiology
Background:
- Lower extremity artery disease (LEAD) prevalence is rising globally.
- Sex-based differences in LEAD are an area of ongoing research and debate.
Purpose of the Study:
- To analyze sex-related differences in patients treated for intermittent claudication (IC).
- To evaluate cardiovascular risk factors, treatment patterns, and long-term outcomes in male versus female IC patients.
Main Methods:
- Analysis of claims data for 42,197 patients with IC (Rutherford grade 1-3) undergoing inpatient treatment.
- Inclusion of diagnostic and procedural data from two years prior to index and five-year follow-up.
Main Results:
- Male patients (68%) were younger but had more cardiovascular risk factors and comorbidities.
- Revascularization rates were high (80%), with endovascular favored in women and surgery in men.
- Long-term outcomes showed male sex as an independent risk factor for mortality and chronic limb-threatening ischemia (CLTI).
Conclusions:
- Male patients with IC present with worse cardiovascular risk profiles.
- Underuse of guideline-recommended pharmacotherapy (statins, platelet inhibitors) was noted, particularly in women.
- Despite initial low LEAD stages, patients faced serious long-term prognoses, with males at higher risk for mortality and CLTI.
Background And Aims:
The prevalence of lower extremity artery disease (LEAD) is increasing worldwide and sex-related differences are a current matter of debate.
Methods:
We analysed claims data on unselected patients with in-patient treatment for LEAD with intermittent claudication (IC; Rutherford grade 1-3) from 01.01.2014 to 31.12.2015. Data files included diagnostic and procedural information from two years before index, and a five-year follow-up.
Results:
Our analysis comprised 42,197 IC patients, thereof 28,520 (68%) male. Male patients were younger (median: 66.4 years vs. 72.6 years) but presented with higher frequency of cardiovascular risk factors such as diabetes (40% female vs. 46% male), atrial fibrillation (13% vs. 17%), chronic coronary syndrome (41% vs. 53%), chronic heart failure (23% vs. 27%), or chronic kidney disease (29% vs. 32%; all p < 0.001; age adjusted). Revascularisation applied in 80% of patients, thereof endovascular approach predominantly in female and surgery in male patients. Concomitant pharmacotherapy with statins (74% at 2 years) and platelet inhibitors (75% respectively) were long lasting below guideline recommendation, under-use being more pronounced in women. Two years after index, one-third of IC patients had subsequent revascularisation, one-quarter progressed to chronic limb threatening ischemia (CLTI), and 2% underwent amputation. Male sex was an independent risk factor for long-term mortality (female HR 0.75; 95%-CI 0.72-0.79; p < 0.001) and CLTI (female HR 0.89; 95%-CI 0.86-0.92; p < 0.001) during follow-up.
Conclusions:
The majority of in-patient treated patients for IC are male, presenting with worse cardiovascular risk profiles. In view of a general under-supply with statins and platelet inhibitors, women received somewhat less often preventive medication. Despite low LEAD stages at index, serious prognosis was observed in the long term. Particularly male patients were at high risk for all-cause mortality and the combined endpoint CLTI and death.
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