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Epidemiology of Peripheral Arterial Disease in Women

BACKGROUND: Peripheral arterial disease is a common disease, which increases with age and presence of vascular risk factors. The extended longevity in industrialized nations coupled with the expanding elderly female population is predicted to lead to an increase in the prevalence of this condition. Little attention has been focussed on gender differences in peripheral arterial disease, or its epidemiology in women. METHODS: MEDLINE search of English-language reports published between 1966 and 2002 and search of references of relevant papers. RESULTS: Across various populations of women with different ages and risk factor levels, the prevalence of peripheral arterial disease ranged between 3% and 29%. Diagnosis in women using a sensitive and specific non-invasive test, the ankle-brachial index, detects about 3-5 times the cases than those diagnosed by history of intermittent claudication alone. Contrary to earlier beliefs, prevalence of peripheral arterial disease is similar in women and men, and women may have more asymptomatic disease. Importantly, women with peripheral arterial disease have 2-4 fold increases in cardiovascular morbidity and mortality. Risk factors for peripheral arterial disease appear to be similar in men and women, however relative risks vary somewhat. CONCLUSIONS: Performing non-invasive testing (e.g. ankle-brachial index) can better diagnose peripheral arterial disease in women than history alone. These women share risk factors with other vascular diseases (coronary and cerebrovascular disease) and should undergo risk factor modification to reduce their cardiovascular morbidity and mortality. More research is needed including aggressive risk factor management in women with asymptomatic peripheral arterial disease.