Why women with peripheral artery disease are underdiagnosed, have worse outcomes

Women with peripheral artery disease (PAD) are underdiagnosed and have worse clinical outcomes compared with men, according to a review published in the European Heart Journal—Quality of Care and Clinical Outcomes.[1] Using the World Health Organization’s model for analyzing gender-related healthcare needs, the review’s authors aimed to learn more about what may have led to this disparity.

Gender differences in diagnosis of PAD

One explanation for this discrepancy in diagnoses may be the fact that women with PAD often have no symptoms or only minor pain or discomfort. Men, on the other hand, are more likely to report more “typical” symptoms of PAD, including pain and cramping in the legs that flares up while walking and is relieved when at rest. 

Even when women do report pain, their pain sometimes continues even when they’re at rest, which could also be a contributing factor to PAD being overlooked or misdiagnosed. In the review, women were more likely than men to be initially misdiagnosed with alternate conditions such as musculoskeletal disorders. 

While women are less likely than men to report experiencing moderate pain and cramping, they are also twice as likely to present with chronic limb-threatening ischaemia, the most severe stage of PAD which can include gangrene or ulcers. 

Potential contributing biological factors to women being at risk for PAD include the fact that they face a higher risk of blood clots, which can cause PAD, and have smaller blood vessels. Additionally, the authors wrote, oral contraceptives have been linked with increased PAD rates. 

Missed diagnoses (and misdiagnoses) lead to poor outcomes

After diagnosis, PAD treatment often involves medication to help manage symptoms and reduce the risks of ulceration, amputation, heart attack and stroke. Surgery is also an option for more severe cases. 

However, the review notes that not only are women less likely to receive PAD medications than men, but they also have lower rates of surgery and are more likely to die after an amputation or open surgery.   

Poor representation may exacerbate poor outcomes

Coauthor Sarah Aitken, a vascular surgeon and Head of Surgery at the University of Sydney, noted that a lack of female medical professionals in the field may play a role in low diagnosis rates and poor outcomes. In addition to the fact that few women are involved in writing PAD guidelines, Aitken also notes that women who are treated by female vascular surgeons have better outcomes than those who are treated by men. 

“Whilst we are working on encouraging women to train as vascular surgeons, the current shortfall means that female patients are unlikely to see a surgeon of the same gender, and research, publications and policies may not fully represent the perspectives of women,” she said in a statement about the review. 

Takeaway: Women shouldn’t ignore leg or calf pain

Associate Professor Kavurma urged women not to ignore symptoms: “Pay attention to aches and pains in your calves when walking or at rest. Ask your GP how likely it is that you have PAD. Women tend to keep going and attribute sore legs to having a busy life. They need to stop and listen to their bodies.”

View the full study here

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