Women with peripheral artery disease are two to three times more likely to have a stroke or myocardial infarction than those without it, yet the condition is often unrecognized and untreated, especially in women, according to a new American Heart Association scientific statement.
The association, in collaboration with the Vascular Disease Foundation and its Peripheral Artery Disease Coalition, said healthcare providers should proactively increase awareness of and test women at risk for PAD, and called for more women-focused research into the disease.
PAD is a serious circulatory disease caused by a buildup of fat and other materials in blood vessels outside the heart, usually in the legs, feet and arms. Left untreated, it can increase myocardial infarction and stroke risk, severely limit walking ability and cause tissue death requiring limb amputation.
About 8 million people in the United States have peripheral artery disease. Most research available suggests nearly equal prevalence among men and women.
Only about 10% of those with PAD experience the warning sign of leg pain typically associated with it, and the pain usually goes away while resting. Many people experience no symptoms, and as a result, few suffering from it receive prompt treatment. Even so, PAD care leads to more than 1.1 million medical office visits annually, according to the new statement.
“The rate of deaths and the healthcare costs associated with PAD are at least comparable to those of heart disease and stroke,” said Alan T. Hirsch, MD, lead author of the statement and professor of medicine, epidemiology and community health at the Lillehei Heart Institute at the University of Minnesota Medical School in Minneapolis. “Women, in particular, suffer an immense burden from peripheral artery disease, yet current data demonstrate most women still remain unaware of their risk.”
Therefore this common disease often goes unrecognized among women and all people ages 50 and older, who are most likely to develop PAD, he said.
“Although PAD is known to affect women and men equally, research in women has lagged far behind that in men,” Hirsch said. “As healthcare providers, we must take seriously our responsibility to include women as a key target audience when we work to study, prevent, diagnose and treat PAD.”
Clinical trials have not included an adequate number of women to provide a clear understanding of how the disease progresses, or to determine with accuracy the incidence and prevalence of peripheral artery disease in women, the authors said. They recommend conducting more research studies of PAD specifically among women and pooling results from previous studies to obtain an adequate sample size of females.
Another recommendation is to fund new research that would help determine how gender may affect the rate of development of PAD, the response to medications or the potential benefits of vessel-opening procedures. The authors said all heart health promotion campaigns, such as the American Heart Association’s Go Red For Women, should provide specific education regarding peripheral artery disease risk, screening and treatment in women.
Treatment of PAD includes diet and lifestyle changes, medication and supervised exercise. Rarely, patients may require procedures to insert stents to open constricted blood vessels or surgical bypass surgery. Typically, diagnosis involves a simple test called an ankle-brachial index to compare arm blood pressure to leg blood pressure.
The statement is published in Circulation: Journal of the American Heart Association. A PDF is available at http://bit.ly/AkCu7r.