Peripheral arterial disease in women

Area of Science:

• Cardiovascular Medicine
• Vascular Biology
• Epidemiology

Background:

• Peripheral arterial disease (PAD) is a common manifestation of atherosclerosis, affecting both sexes.
• Classical atherosclerosis risk factors are similarly distributed, but sex-specific factors influence PAD prevalence and presentation.
• PAD is often underdiagnosed in women due to more frequent asymptomatic disease and less screening, potentially delaying diagnosis and treatment.

Purpose of the Study:

• To explore differences in PAD presentation, risk factors, and treatment between men and women.
• To investigate the role of estrogen and hormone replacement therapy (HRT) in the development of PAD in women.
• To highlight potential disparities in PAD diagnosis and management for women.

Main Methods:

• Review of epidemiological data on PAD prevalence and risk factors in men and women.
• Analysis of studies examining the impact of estrogen and HRT on atherosclerosis and PAD.
• Comparison of treatment approaches for PAD in different sexes.

Main Results:

• Women exhibit more asymptomatic PAD and undergo less frequent screening, leading to potential underestimation of prevalence.
• Estrogen demonstrates vasoprotective properties in younger women, but this effect diminishes with age.
• Short-term HRT (<1 year) does not reduce PAD risk and may increase vascular intervention morbidity; long-term HRT (>1 year) may decrease PAD risk if initiated early post-menopause.
• PAD treatment strategies may differ between men and women.

Conclusions:

• Sex-specific factors significantly impact PAD development, presentation, and diagnosis.
• The role of estrogen and HRT in PAD risk is age- and duration-dependent.
• Addressing diagnostic and treatment disparities is crucial for improving outcomes in women with PAD.