Women & Peripheral Artery Disease

By Sondra Forsyth

Women, especially older women, face greater limits on their lifestyle and have more severe symptoms as a result of peripheral artery disease (PAD) than men do. The condition happens when fatty deposits build up in arteries outside the heart, usually the arteries supplying fresh oxygen and blood to the arms, legs and feet. About 8 million Americans have peripheral artery disease. Now study done at the University of Michigan and published in May 2014 in the Journal of the American College of Cardiology has shown that minimally invasive procedures used to unclog arteries are just as successful in women as they are in men.

A release from the university quotes senior author P. Michael Grossman, M.D. as saying,“We found that women had excellent outcomes compared to men, even though they were older and had more severe disease.”

Before treatment, women were at higher risk of amputation, and more likely to suffer from leg pain at rest or ulceration, called critical limb ischemia. Yet fewer women complained of leg discomfort, fatigue or cramping with activity known as claudication, according to the study.

“The reasons for differences in symptoms are unclear, and deserve further study,” Grossman said. “It does indicate that we need to be vigilant in asking women about leg discomfort and screening women for PAD.”

The team used Michigan’s Blue Cross Blue Shield of Michigan Cardiovascular Consortium PVI registry, which collected data from 16 Michigan hospitals about percutaneous peripheral vascular intervention.

A total of 12,379 patients had lower extremity PVI from 2004 to 2009, and the overall procedural success rate of PVI was 79 percent for women compared to 81 percent for men. There was also no difference in heart attacks or strokes.

It was surprising, researchers say, to observe no gender-related differences in procedural success considering that women experienced more transfusions, vascular complications, and embolisms.

“The data suggests women may benefit to a greater degree with an invasive percutaneous strategy for the management of PAD, particularly if complications can be avoided,” says study author Elizabeth Jackson, M.D., cardiologist and director of the University of Michigan Women’s Heart Program.

According to the study, women were less likely than men to be prescribed cholesterol-lowering statins and antiplatelet therapy before the procedure.

“More could be done to ensure all patients with PAD are prescribed these medications, particularly women,” Jackson says.  

Some patients need minimally invasive procedures to unclog arteries and restore blood flow, but lifestyle changes, such as quitting smoking, exercise and medications are known to slow or even reverse the symptoms of PAD.

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Additional authors:  Theodore Schreiber, M.D., Jeffrey R. Rubin, M.D., Robert Cuff, M.D., Katherine Gallagher, M.D., Peter K. Henke, M.D., and Hitinder Gurm, M.D.