Women with advanced vascular disease have more complications but not common risks
Research by UC Davis physicians has found that women with a severe arterial condition that restricts circulation to arms and legs are at greater risk than men of experiencing a heart attack or stroke yet are less likely to have a history of heart disease or diabetes — common risk factors for major cardiovascular events.
The study, published in the current issue of Vascular Medicine, details gender-specific differences in patient characteristics and outcomes for critical limb ischemia, which is the most advanced form of peripheral artery disease (PAD).
“We know that women are generally diagnosed with PAD at later ages and with more advanced disease when compared to men,” said lead author Caroline McCoach, a chief resident in the UC Davis Department of Internal Medicine. “Our study is among the first to define clinical distinctions for women so we can optimize treatment approaches for them.”
PAD, which affects an estimated 8 million people in the U.S., occurs when plaque builds up in arteries and reduces blood circulation to the extremities and organs. Smoking, obesity, high blood pressure and high cholesterol are linked with the disease. PAD that reaches the point of critical limb ischemia can lead to severe pain, wounds that do not heal and, sometimes, gangrene that requires limb amputation.
Last year, the American Heart Association issued a call to action to the scientific community to help close the gender gap in knowledge about PAD, since research has historically focused on men. UC Davis has a registry — called PAD-UCD — of patients’ diagnoses, clinical features, treatments and outcomes that can help close that gap.
“Given that UC Davis has a large vascular center that provides current treatments for every form of PAD, establishing the database made good sense,” said study senior author John Laird, medical director of the UC Davis Vascular Center and a specialist in developing stem cell treatments for vascular disease. “We are in an excellent position to expand knowledge of PAD for all providers.”
For the study, Laird, McCoach and their team used PAD-UCD to evaluate data on 219 patients (97 women and 122 men) with critical limb ischemia who received peripheral angiography and subsequent treatment such as endovascular intervention, surgical bypass grafting or amputation between 2006 and 2010.
They found that women in the study had significantly higher rates than men of major adverse cardiovascular events, including heart attacks and strokes, yet were less likely to have coronary artery disease or diabetes reported in their medical records. When compared to men, women also tended to have vascular disease in more vessels and their disease was more likely to reoccur following intervention.
“In general, women had more complex vascular disease and demonstrated worse post-procedural outcomes, yet didn’t seem to have two of the risks most often associated with those outcomes,” McCoach said.
McCoach added that one possible explanation for this outcome is a lack of understanding of the unique indicators of cardiovascular disease in women, leading to misdiagnosis and underdiagnosis.
“Our study reinforces how important it is for primary-care providers and vascular specialists to evaluate women for PAD, initiate appropriate medical therapy and encourage lifestyle changes as soon as possible in the disease process,” McCoach said. “Statins and anti-platelet therapies together with exercise, eating healthy and quitting tobacco support overall cardiovascular health and could prevent PAD from progressing.”
The researchers hope their work will be repeated in order to build a more complete picture of what critical limb ischemia is like for women nationwide, and that it will inspire investigations to uncover the unique genetic-hormonal distinctions for PAD among women.
“Our study provides a good start toward eliminating gender bias in PAD identification and treatment and reducing missed opportunities to improve health for women,” McCoach said.
Laird and McCoach’s UC Davis co-authors on the study were Ehrin Armstrong, Satinder Singh, Usman Javed, David Anderson, Khung Keong Yeo, Gregory Westin, Nasim Hedayati and Ezra Amsterdam.
The study had no external funding. A copy of “Gender-Related Variation in the Clinical Presentation and Outcomes of Critical Limb Ischemia” is available at http://vmj.sagepub.com/
UC Davis Health System is improving lives and transforming health care by providing excellent patient care, conducting groundbreaking research, fostering innovative, interprofessional education and creating dynamic, productive partnerships with the community. The academic health system includes one of the country's best medical schools, a 619-bed acute-care teaching hospital, a 1,000-member physician's practice group and the new Betty Irene Moore School of Nursing. It is home to a National Cancer Institute-designated comprehensive cancer center, an international neurodevelopmental institute, a stem cell institute and a comprehensive children's hospital. Other nationally prominent centers focus on advancing telemedicine, improving vascular care, eliminating health disparities and translating research findings into new treatments for patients. Together, they make UC Davis a hub of innovation that is transforming health for all. For more information, visit healthsystem.ucdavis.edu.