Article Impact Level: HIGH Data Quality: STRONG Summary of Circulation, CIR.0000000000001310. https://doi.org/10.1161/CIR.0000000000001310 Dr. Esther S.H. Kim et al.
Points
- Women experience peripheral vascular disease (PVD) differently than men, with higher rates of atypical symptoms, greater functional decline, and later diagnoses, leading to worse outcomes.
- Black women have a 27.6% lifetime risk of peripheral artery disease (PAD), significantly higher than white women (19%), yet they are less likely to receive evidence-based treatments.
- Women with aortic disease face greater risks, including a threefold higher likelihood of aneurysm rupture at the same size as men and increased mortality and stroke risks after thoracic endovascular aortic repair (TEVAR).
- Women’s increased risk of complications and different disease progression patterns highlight the need for sex-specific screening, diagnosis, and treatment approaches.
- The statement urges greater inclusion of women in clinical trials, improved screening tailored to female-specific symptoms, and further research into optimal treatment strategies for women with PVD.
Summary
A recent scientific statement published by the American Heart Association addresses sex-based disparities in peripheral vascular disease (PVD), particularly in the context of prevalence, risk factors, symptoms, diagnosis, treatment, and outcomes. The statement highlights significant differences in how PVD manifests in men and women, emphasizing the impact these disparities have on the prevention and management of conditions such as peripheral artery disease (PAD) and aortic disease. For instance, while PAD affects men and women at similar rates overall, women are more likely to experience atypical symptoms and greater functional decline, such as slower walking speeds and shorter distances covered. Moreover, Black women have a 27.6% lifetime risk of PAD compared to 19% for white women, yet they are often less likely to receive evidence-based treatments (p<0.05).
In the case of aortic disease, women are diagnosed later and with more severe disease, which leads to a higher risk of complications like aneurysm rupture. For example, in the U.K. Small Aneurysm Trial, women were three times more likely than men to experience aneurysm rupture at the same aneurysm size, with 30% of ruptures occurring in smaller aneurysms in women compared to only 8% in men (p<0.01). Additionally, women undergoing thoracic endovascular aortic repair (TEVAR) face higher mortality rates and stroke risk compared to men, with in-hospital mortality for acute aortic syndromes at 30% for women compared to 21% for men (HR: 1.45, 95% CI: 1.1–2.0). These disparities underscore the need for sex-specific clinical guidelines, particularly in the management of aortic aneurysms and PAD.
To address these disparities, the statement calls for increased representation of women in clinical trials and improved screening methods tailored to women’s unique presentations of PVD. It also emphasizes the need for further research to determine optimal treatment strategies for women. A focus on sex-specific differences in disease progression and response to interventions is essential to improving outcomes for women with PVD, suggesting that a more tailored approach to treatment and prevention could help mitigate these disparities in the future.
Link to the article: https://www.ahajournals.org/doi/10.1161/CIR.0000000000001310
References Kim, E. S. H., Arya, S., Bryce, Y., Gornik, H. L., Long, C. A., McDermott, M. M., West Pollak, A., Rowe, V. L., Sullivan, A. E., Whipple, M. O., & on behalf of the American Heart Association Council on Peripheral Vascular Disease; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; Council on Genomic and Precision Medicine; Council on Quality of Care and Outcomes Research; and Stroke Council. (2025). Sex differences in peripheral vascular disease: A scientific statement from the american heart association. Circulation, CIR.0000000000001310. https://doi.org/10.1161/CIR.0000000000001310
