Sex differences in peripheral artery disease detection during community-based screening in underserved populations...

Females with peripheral artery disease (PAD) often present with atypical or advanced symptoms and experience worse outcomes compared with males. The Comprehensive Heart and Multidisciplinary Limb Preservation Outreach Networks delivers free cardiovascular screenings in vascular deserts, reaching underserved communities with limited access to care. This study evaluated sex-based disparities in PAD risk classification and PAD detection among the Comprehensive Heart and Multidisciplinary Limb Preservation Outreach Networks participants in California.

We performed a cross-sectional analysis of 736 participants screened between 2022 and 2025. Screening included a demographic/health questionnaire, nonfasting lipid panel, hemoglobin A1c, and blood pressure measurement. At-risk status was determined using the European Society for Vascular Surgery guidelines for asymptomatic PAD. At-risk participants underwent toe-brachial index (TBI) measurements. PAD was defined as TBI < 0.7. Primary outcomes were at-risk classification and TBI-defined PAD. Logistic regression was used to evaluate the association between sex and the outcomes.

Female participants comprised 54.3% (n = 400) of participants, with a mean age of 53.1 ± 15.7 years. Comorbidities were similar between sexes, although smoking was more prevalent among male participants (27.4% vs 10.5%; P < .001). Overall, 43% of participants were Hispanic, 51% unemployed, and 26% reported grade school as the highest education. There was no significant difference in at-risk status by sex (odds ratio, 0.78; 95% confidence interval, 0.58-1.05; P = .10). Among at-risk participants, PAD prevalence was significantly higher in female vs male participants (10.9% vs 2.8%; P < .001). Female sex was associated with increased odds of meeting TBI criteria for PAD (odds ratio, 4.21; 95% confidence interval, 1.80-11.52; P < .001), persisting after multivariable adjustment.

Despite similar risk classification, female participants were significantly more likely to meet TBI criteria for PAD at screening. These findings suggest that sex-based disparities in PAD may already exist at the point of detection, highlighting the importance of improved screening strategies and increased awareness in females, particularly in underserved populations.