Analysis of differences in treating peripheral arterial disease in men and women

PAD is a frequent and growing pathology in recent years. Knowledge of PAD in women compared to men is surprisingly low compared to literature data concerning other cardiovascular diseases and general illnesses. For example, studies comparing endovascular or surgical revascularization in men versus women have reported conflicting results.

In this retrospective cohort study based on medical records, we included adult patients (men and women) who had been hospitalized in the vascular surgery department of Nantes University Hospital Center for PAD revascularization by angioplasty with or without stent. The primary outcome was a composite of revascularization failures, collected intraoperatively, at one month (M1) and at one year (A1). Secondary outcome included various risk factors for PAD.

A total of 447 patients including 315 men and 132 women were enrolled in the trial. The prevalence of tobacco was different between the two groups with 245 men (78.0%) who were smoking or had quit smoking, while only 13 women (9.8%) were smoking and 30 (22.7%) had quit smoking. Post-surgical anticoagulant, calcium channel blocker, beta-blocker and antiplatelet drugs were similarly prescribed in men and women. Differences were found for treatment with a renin-angiotensin system inhibitor, prescribed in 48.5% in women and in 60.2% in men (P=0.028). Similarly, statin treatment was prescribed in 59.1% of women and 76.4% of men (P<0.001). The 1-month incidence of the primary-outcome was higher in women than in men (27.8% vs. 19.3%), with a risk ratio of 1.43 (95% confidence interval [CI], 0.99 to 2.06; P=0.071). At one year, we found a risk ratio of 1.13 (95% confidence interval [CI], 0.94 to 1.37; P=0.20). In multivariable regression model, the adjusted odds ratio for primary outcome was 1.65 for women/men (95% confidence interval [CI], 0.95 to 2.86; P=0.075). Finally, there were significantly more cardiovascular deaths in women than in men at one month (P=0.003) and one year (P=0.005).

Women are more at risk of failure after lower extremity surgery, especially in the first month. After a year of hindsight, women have more cardiovascular mortality than men. This can be explained by management at a later stage, a higher age or more distal damage, but also by differences in optimal medical treatment in men and women.