Sex-Specific Differences in Patients with Sarcopenia and Peripheral Artery Disease

Background: In patients with peripheral arterial disease (PAD), the presence of sarcopenia is associated with increased morbidity and mortality. However, sarcopenia is widely underrecognized and scientifically scarcely researched in PAD. Thus, we aimed to investigate sex-specific differences in PAD patients with sarcopenia. Methods: All hospitalizations due to PAD in Germany with additional coding for sarcopenia 2005-2020 were included in this analysis and stratified for patients' sex. Female and male sarcopenic PAD patients were compared regarding patient characteristics, performed therapy and clinical outcome. Results: Overall, 3282 patient hospitalizations admitted due to PAD with sarcopenia were identified in Germany in 2005-2020. The majority of sarcopenic patient-cases were of male sex (N = 1821; 55.5%). Female PAD patients with sarcopenia were older (81.0 [75.0-87.0] vs. 76.0 [68.0-82.0] years, p < 0.001) and revealed a higher comorbidity burden mirrored by higher Charlson Comorbidity Index (7.0 [5.0-8.0] vs. 6.0 [3.0-8.0], p < 0.001). While surgical revascularization of the lower extremity was more often performed in hospitalizations of male sarcopenic PAD patients (17.0% vs. 14.0%, p = 0.018), interventional endovascular revascularization was similarly used in both sexes (12.7% vs. 11.8%, p = 0.429). Amputations were more often performed in male sarcopenic PAD patients (27.2% vs. 21.7%, p < 0.001). In-hospital death (8.9% vs. 6.5%, p = 0.009) and MACCE (11.0% vs. 9.1%, p = 0.070) occurred more often in female than in male sarcopenic PAD patients. Conclusions: We detected significant sex-specific differences in patient profile, performed treatment approaches, and mortality among hospitalized patients with PAD and concomitant sarcopenia. A low number of patients coded with sarcopenia indicates a remarkable under-recognition of sarcopenia in PAD.