Unveiling the Sex-Based Divide: Exploring Sex Differences in Peripheral Artery Disease

Peripheral artery disease (PAD) is a leading cause of cardiovascular morbidity and mortality. Despite its growing clinical burden, the disease remains relatively understudied and underdiagnosed relative to other cardiovascular diseases, especially in female patients. While PAD prevalence is similar in males and females, sex-based disparities have been noted in the presentation, diagnosis rates, treatment methods, and clinical outcomes of PAD patients. This article serves to provide an overview of existing knowledge on sex-based differences in the epidemiology, pathophysiology, clinical presentation, management, and patient outcomes of PAD.

Female patients with PAD remain underdiagnosed and undertreated, with females receiving lower referral rates to supervised exercise therapy and guideline-directed medical therapy despite observing similar benefits from treatment as males. Surgical interventions also see conflicting outcomes in male and female patients, with females now seeing improved outcomes despite prior studies indicating worsened quality of life. Cardiovascular risk factors such as history of smoking, chronic kidney disease, and diabetes also place females at heightened risk of PAD compared to male patients. There are also physiological disparities observed that affect the presentation and diagnosis rates of PAD, with female patients seeing increased platelet reactivity and aggregation yet receiving later diagnoses at more severe stages due to postmenopausal effects. In addition, female patients remain underrecruited in clinical research studies for cardiovascular disease, highlighting a need for further research focused on female patients and sex disparities in PAD. This article identifies key disparities between male and female patients with PAD, with inequities noted in the epidemiology, pathophysiology, risk factors, clinical presentation, and treatment approaches and outcomes. Further research is warranted to better understand sex-based differences in PAD and better inform patient treatment decisions.