Peripheral arterial disease in women is underestimated due to more frequent asymptomatic disease and less frequent screening, with sex-specific differences in risk factors, estrogen's vasoprotective role, hormone replacement therapy effects, and treatment outcomes.
Key Findings
Background
PAD is more frequently asymptomatic in women than in men, contributing to underestimation of its prevalence in women.
More frequent asymptomatic disease in women than in men is identified as a key factor leading to underestimation of PAD prevalence
Less frequent screening in women compounds the underestimation of PAD prevalence
These factors may cause delayed diagnosis and treatment of PAD in women
Background
Estrogen hormones have vasoprotective properties that lower the prevalence of atherosclerosis in women of younger age.
Estrogen hormones are described as having 'vasoprotective properties'
This vasoprotective effect lowers the prevalence of atherosclerosis specifically in women of younger age
Estrogen probably does not have a protective role against the development of cardiovascular disease in women of older age
Results
Hormone replacement therapy (HRT) of less than one year does not appear to reduce the odds of developing PAD in postmenopausal women and may increase vascular intervention morbidity risk.
HRT of less than one year 'does not appear to reduce the odds of developing PAD in postmenopausal women'
Short-duration HRT 'may even increase the risk of morbidity from vascular interventions'
This finding applies specifically to postmenopausal women
Results
HRT administered for more than one year significantly decreases the risk of PAD when initiated early after the last menstruation.
Some studies indicated that HRT for more than one year 'significantly decreases the risk of PAD'
The risk reduction is contingent on HRT being 'administered early after the last menstruation'
This finding contrasts with shorter duration HRT which showed no benefit or potential harm
Background
PAD shares classical atherosclerosis risk factors between men and women, but additional sex-specific factors create differences between the two groups.
In both sexes, PAD is related to 'classical risk factors of atherosclerosis, which are similarly distributed'
Some additional factors determine differences between men and women beyond classical risk factors
Treatment of PAD in women 'differs to some extent from men'
Kozak M, Poredoš P, Blinc A, Kaja Ježovnik M, Poredoš P. (2024). Peripheral arterial disease in women.. VASA. Zeitschrift fur Gefasskrankheiten. https://doi.org/10.1024/0301-1526/a001137