Sex Disparities in Medical Management: Influence on Morbidity in Peripheral Arterial Disease

Peripheral artery disease (PAD) has traditionally been identified as a male-dominant disease; however, current literature suggests that female patients may be at increased risk of adverse outcomes. Given the key differences between sexes, we conducted a retrospective review to identify presurgery risk predictors that may increase morbidity within the female PAD population.

Data were extracted from the Vascular Quality Initiative database for patients who underwent suprainguinal or infrainguinal bypass surgery for PAD between 2009 and 2020. Binary logistic regression was used to assess for sex differences in risk predictors, drug administration characteristics, and postoperative outcomes; analysis was adjusted for potential covariates.

A total of 79,981 patients were included based on our eligibility criteria, 34% of which were female. Female patients typically presented at an older age, were more frequently hypertensive and diabetic, and were significantly less likely to be prescribed angiotensin-converting enzyme inhibitors, anticoagulants, and statin preoperatively. Women had a significantly higher postoperative risk of all-cause morbidity (1.06 [1.03, 1.09];P = 0.004), mortality (1.09 [1.05, 1.13];P < 0.001), stroke (1.48 [1.35, 1.62];P < 0.001), and major adverse cardiovascular events (1.19 [1.10, 1.28];P < 0.001) when compared to male patients. No preoperative statin use was a significantly greater predictor for all-cause morbidity in women.

Following surgery for PAD, our results suggest that female patients have a significantly greater risk of adverse outcomes as compared to male patients. Reduced administration of key medication including statin and angiotensin-converting enzyme inhibitors along with a greater comorbidity burden in female patients may be major contributors to this greater morbidity risk.