Meaningful disparities exist between men and women in the prevalence, risk factors, and symptoms of peripheral vascular disease (PVD), according to a new scientific statement from the American heart Association. published in the journal Circulation, the statement underscores the profound impact these differences have on prevention, diagnosis, treatment, and overall outcomes for women affected by PVD. The American Heart Association emphasizes the urgent need for further research to address these inequities and improve the quality of life for women.

The American Heart Association’s new scientific statement, titled “Sex Differences in Peripheral Vascular Disease,” aims to summarize current knowledge regarding the differences between men and women wiht PVD. It highlights disparities in risk factors, screening processes, treatment approaches, and health outcomes. the statement also outlines key research priorities designed to mitigate these disparities and promote health equity for all.

Dr. Esther S.H. Kim, M.D., M.P.H.,FAHA,chair of the writing group for the new scientific statement,emphasized the critical need for increased attention to PVD in women. Dr. Kim is the Izard Family Distinguished Chair in Cardiovascular medicine,a professor of medicine at Wake Forest University School of Medicine,and director of the Center for Women’s Cardiovascular Health at atrium Health in charlotte,North Carolina. According to Dr. Kim, Peripheral vascular disease is often under-recognized and understudied in women. She added, While differences in heart disease between men and women are increasingly recognized, equivalent focus on vascular diseases affecting blood vessels outside the heart remains lacking. In order to improve the quality of life and prolong the lives of women with PVD, more research is needed to identify and address these disparities.

Disparities in Peripheral Vascular Disease

The American Heart Association statement highlights numerous disparities across various types of PVD, including differences in risk factors, symptoms, screening efficacy, treatment protocols, and patient outcomes. Understanding these differences is crucial for improving women’s cardiovascular health.

Peripheral Artery Disease (PAD)

Peripheral Artery Disease (PAD), the most common form of PVD, restricts blood flow to the limbs and affects men and women at similar rates overall. However, women are more likely to experience no symptoms or atypical signs of PAD, leading to greater functional decline compared to men. Women with PAD tend to walk at slower speeds and cover shorter distances, highlighting the functional limitations they frequently face. Furthermore, women with PAD may be less likely to receive guideline-recommended treatment or participate in supervised exercise programs.

The statement also notes that PAD is more prevalent in Black women, who have a higher lifetime risk (27.6%) compared to white women (19%). Despite this increased risk, Black women are often less likely to receive evidence-based recommended treatments, according to the Association’s 2024 Guideline for the Management of Lower Extremity PAD.

Aortic Disease

Women with aortopathy, conditions affecting the aorta, tend to be diagnosed at older ages and present with more severe disease compared to men. While women have a lower incidence of some aortic conditions, such as aneurysms, due to the protective effect of estrogen hormones, they face a disproportionately higher risk of severe complications, including aneurysm rupture and mortality.the U.K. Small Aneurysm Trial revealed that women were three times more likely than men to experience aneurysm rupture at the same size of aneurysm. Moreover, 30% of aneurysm ruptures in women occurred with smaller aneurysms, compared to only 8% in men.

These disparities persist even with treatment. Women undergoing minimally invasive procedures such as thoracic endovascular aortic repair (TEVAR) face higher short- and long-term mortality rates and an increased risk of stroke after surgery. In acute aortic syndromes, including dissection, intramural hematoma (collection of blood within the aortic wall), and penetrating aortic ulcer, in-hospital mortality for women is 30% compared to 21% for men. Screening guidelines for aortic aneurysms recommend lower repair thresholds for women (5.0 cm) than for men (5.5 cm); though, these thresholds may not fully reflect women’s unique risk factors.

Peripheral Aneurysms and Artery Disorders

Conditions such as fibromuscular dysplasia and vascular Ehlers-Danlos syndrome (vEDS) vary in their frequency and outcomes between men and women. Fibromuscular dysplasia is 5–9 times more common in women than men, while popliteal (behind the knee) artery aneurysms occur about 20 times more often in men.

Atherosclerotic Extracranial Carotid Artery Disease

Carotid plaque composition in the neck and brain and the impact on stroke risk, along with treatment options and outcomes, are also different for women.Sex-specific risk factors for stroke in women include preeclampsia (high blood pressure during pregnancy), older age at menopause, and use of estrogen therapy.While women might have smaller plaque size than men, studies indicate that men experience intraplaque hemorrhages (bleeding with arterial plaque) at higher rates, which can increase stroke risk.

Atherosclerotic Renal and Mesenteric Artery Disease

Research on differences in kidney and mesenteric arteries (blood vessels that take blood from the aorta to the gastrointestinal tract) disease remains limited. Studies have found women are three times more likely to be affected with chronic mesenteric ischemia (reduced blood flow) than men. Studies also suggest Black adults with renal artery stenosis (narrowing of the blood vessels that supply blood to the kidneys) have higher rates of severe or resistant high blood pressure.

Vasculitis

The growth of vasculitis, an autoimmune disease that causes inflammation in the blood vessels, and clinical features vary strongly by type. Takayasu arteritis occurs five times more often in women, and women are 2–3 times more likely to develop giant cell arteritis. Takayasu is more common in younger women, ages 15–30 years old, while giant cell arteritis incidence is highest among people ages 70- to 80-years-old.In addition, the mortality rate for Takayasu arteritis is two times higher in women, and women with giant cell arteritis who receive prednisone-only treatments are five times more likely to face treatment challenges compared to men.

PVD leads to significant illness and health complications. Though, the disparities between women and men hinder equitable outcomes. Identified disparities in effective prevention,diagnosis,treatment and care underscore the importance of tailored prevention and treatment strategies.

Esther S.H. Kim, M.D., M.P.H., FAHA, chair of the writing group for the new scientific statement

Addressing Knowledge Gaps and Future Research

The American Heart Association statement emphasizes the need to prioritize research to define differences in PVD between men and women. Future research, from research at the cellular level to clinical trials, should include sex in their design and reporting. Suggestions include:

• Ensure adequate depiction of women in clinical trials: Trials should enroll more women to allow for meaningful analysis of sex-specific differences in treatment efficacy,safety,and outcomes. Enrollment should mirror the prevalence of the condition in women, ensuring balanced portrayal.
• Analyze data by sex: Research and clinical trials should include analyses to better understand differences by sex in response to treatments and interventions.
• 
  
  

  Unmasking the Silent Killer: Why Women Face Unique Challenges with Peripheral Vascular Disease

  Did you know that women experience peripheral vascular disease (PVD) differently than men, leading to delayed diagnosis and poorer outcomes? This disparity is a critical public health concern, and understanding the nuances is crucial for improving women’s cardiovascular health.

  Interviewer: Dr. Anya sharma, a leading expert in women’s cardiovascular health, joins us today to shed light on the critical issue of PVD disparities in women. Dr. Sharma, can you begin by explaining what peripheral vascular disease is and why it’s so important to understand the sex-specific differences?

  Dr. Sharma: Peripheral vascular disease encompasses a range of conditions affecting blood vessels outside the heart. This includes peripheral artery disease (PAD), aortic disease, vascular disorders like fibromuscular dysplasia, and vasculitis. It’s crucial to understand sex-specific differences as women frequently enough present with atypical symptoms, leading to diagnostic delays and ultimately impacting treatment and prognosis. This results in meaningful health complications and reduced quality of life.

  Interviewer: The article highlights significant disparities in PAD. Could you elaborate on the unique challenges women face with this prevalent form of PVD?

  Dr. Sharma: Absolutely. While PAD affects men and women at similar rates,women frequently experience atypical symptoms or even no symptoms at all. This means they may not seek medical attention until the disease has progressed substantially. For instance, women might experience fatigue or leg cramps, which are easily misattributed to other causes. This delayed diagnosis means women ofen present with more advanced PAD, requiring more intensive treatment and resulting in poorer functional outcomes.Furthermore, women may be less likely to receive guideline-concordant treatment compared to their male counterparts. The impact of this is significant,leading to poorer long term quality of life.

  Interviewer: The article also mentions disparities in aortic disease. Can you explain why women face higher risks and poorer outcomes?

  Dr. Sharma: While it’s true that women have a lower incidence of some aortic conditions like aneurysms, likely due to the protective effects of estrogen, they experience disproportionately higher rates of severe complications when they do develop these conditions. They’re more likely to experience aneurysm rupture at smaller aneurysm sizes compared to men, resulting in higher mortality rates. This highlights the need for tailored screening and treatment strategies for women. Moreover, even with minimally invasive procedures like TEVAR, women experience higher short- and long-term mortality and increased stroke risk compared to men. This underscores the crucial need for further research that specifically examines women’s unique responses to these treatment approaches, such as endovascular and open surgical aortic procedures.

  Interviewer: What about other types of PVD, such as fibromuscular dysplasia and vasculitis? How do those vary between the genders?

  Dr. Sharma: These conditions also demonstrate significant sex differences. Fibromuscular dysplasia, a non-atherosclerotic vascular disease, is far more prevalent in women, occurring 5-9 times more often than in men. In contrast, popliteal artery aneurysms are far more common in men. Similarly, certain types of vasculitis, autoimmune disorders causing blood vessel inflammation, are strongly skewed towards women. Take,for example,Takayasu arteritis,which is five times more common in women,displaying both unique clinical characteristics and higher mortality rates. there is a clear need for more research into all of these diseases to better analyze the causes of these differences, as well as to develop tailored therapies for these conditions in women.

  Interviewer: The article emphasizes the need for more research. What specific steps are needed to address these knowledge gaps, especially surrounding treatment and care for women with PVD?

  Dr.Sharma: We urgently need to improve representation of women in clinical trials for PVD. This requires a concerted effort to enroll sufficient numbers of women to enable meaningful analysis of sex-specific differences in treatment response, efficacy, safety, and overall outcomes. This data is crucial to truly personalize these vascular interventions for female patients. Further, existing data should be analyzed by sex to uncover the subtleties of treatment response which may be hidden in overall data pools. new research should be designed and conducted specifically to uncover the underlying reasons for these profound sex differences in the prevalence, presentations, severity, and responses to treatments of vascular disease in women.

  Interviewer: Dr. Sharma, thank you for your insightful perspectives on this critical issue. this discussion underscores the critical need for increased awareness, improved diagnostic tools, and tailored treatment strategies specifically addressing the unique challenges faced by women with PVD. We must prioritize research and advocate for equitable healthcare to improve the health and well-being of women suffering from this frequently enough-overlooked condition.We encourage readers to share their thoughts and experiences in the comments below. Let us work together to advocate for improved detection and treatment options for all women affected by this condition.

  Related posts:

  "Discover the Medicinal Benefits of Forsythia: Anti-inflammatory, Antiviral, and Antibacterial Effec...

  US General Surgeons Warn of Worsening Mental Health Crisis Threatening Democracy

  Iodine and its Importance for Men Who Exercise Regularly

  Mexico First Country in Latin America to Market Pfizer and Moderna Covid-19 Vaccines, Sparking High ...

  Share this:

  • Facebook
  • X

  Related