The symptoms for Peripheral arterial disease (PAD) that are seen in women

differ from those of men, as confirmed in a new scientific statement

released by the American Heart Association (AHA). Women with PAD have four
times the risk of heart attack and stroke, according to the Society of Interventional
Radiology Foundation’s Legs For Life® national PAD screening program

“The AHA felt it was important to highlight the gender basis of this pandemic,"
stated Alan T. Hirsch, MD Professor of Medicine and Lillehei Heart Institute at the
University of Minnesota, and lead author of this scientific statement.

Lower-extremity peripheral arterial disease (PAD) commonly affects as

many as 8 million Americans and 800, 000 Canadians. While PAD is
expected to rise disproportionately in women as the population ages, 75%
of adults had no awareness of PAD as a disease, and those at highest risk
for PAD (the elderly and minorities) were the least informed.

http://www.theheart.org/viewDocument.do?document=http%3A%2F%2F
circ.ahajournals.org The AHA Call to action: Women and peripheral artery disease
offers a thorough assessment of the evidence concerning PAD in women,
and provides strong support to reverse conventional thinking that PAD is a
‘man’s disease’.

Just as women tend to present with heart attack symptoms that differ
from those commonly seen in men, they also often exhibit different
symptoms of PAD. For example, classic, “male symptoms”, include
cramping pains and overt discomfort in the muscles on exercise where as
symptoms more likely to occur in women, include any discomfort in the
legs or in the heel that is present at rest or during exercise or may not be
confined to the muscle.

Other highlights from this scientific statement includes:

• While the age-dependent prevalence of PAD in adult women is lower

than in men, the total population burden of PAD appears to be
higher for women.
• A trend toward higher event rates for women than for men appears to
occur with an ABI <0.90.
• Women (more so in African Americans) are more likely than men to
experience graft failure or limb loss. There is therefore a need to
identify women with or at risk for PAD, especially black women, to
lower cardiovascular ischemic event rates, loss of independent
functional capacity, and ischemic amputation rates.

Although there are as many doctor office visits for PAD as for stroke in women,
only 25% of women are aware of PAD. Therefore, clinicians need to recognize
the sex differences in symptom presentation, to think beyond muscles and joints
when addressing leg discomfort, gain better understanding of the ankle
brachial index (ABI) test, and better inform women of their risk for PAD.

And current data clarify that PAD actually affects more women than men. This
bursts the myth that this is a disease of men," chair of the writing group, Dr Alan
T Hirsch (University of Minnesota, Minneapolis), commented to heartwire.

The statement, entitled "Call to action: Women and peripheral artery disease," is
endorsed by the Vascular Disease Foundation and its Peripheral Artery
Disease Coalition and was published online February 15, 2012 in Circulation.

Hirsch said: "This is a call to action for awareness of PAD as a real problem in
women. In 2012, there continues to be a pandemic of PAD. The AHA felt it was
important to highlight the gender basis of this pandemic."

He explained that although there have been past epidemiological studies, it

hasn't really been clear how many women vs men PAD affects.

http://circ.ahajournals.org/content/116/18/2086.full?sid=493c42fb-
81b9-4790-a871-4dee21a515bb Lower-extremity peripheral arterial
disease (PAD) is common, affecting up to 12% to 29% of the elderly 1 and
as many as 8 million Americans and ≈800 000 Canadians.2,3 Intermittent
claudication, the most frequent symptom of PAD, impairs quality of life
and functional status.4,5 Individuals with PAD suffer a 5-fold-increased
relative risk of a heart attack and 2- to 3-fold-greater risk of stroke and
total mortality than those without PAD.6 Individuals with PAD suffer
combined annual rates of heart attack, stroke, and hospitalization that
are comparable to or greater than rates observed in individuals with
established coronary artery disease or stroke.7,8 PAD has been recognized
as a coronary heart disease risk equivalent in national cardiovascular
disease (CVD) treatment guidelines.5,9,10 The prevalence of PAD is
expected to increase as the population ages.2,11

Yet, although the high prevalence and ischemic risk of PAD contribute to
high rates of CVD morbidity and mortality, current data suggest that PAD
detection and treatment are lower than for other forms of atherosclerotic
arterial disease.12–15 A minority of individuals with PAD are aware of their
diagnosis, which contributes to adverse health outcomes. Prior public
education efforts linking exposure to atherosclerosis risk factors as a
cause of PAD have been limited; thus, general public awareness of PAD
risk is assumed to be low. Within this context, a national effort has been
initiated to offer the public improved access to PAD-related health
information16 as a key component in support of the congressionally
mandated Healthy People 2010 initiative (www.healthypeople. gov).

This bursts the myth that this is a disease of men.

Hirsch added that although there are as many doctor office visits for PAD as for
stroke in women, only 25% of women are even aware of PAD. "There needs to
be a focus on greater information being made available so that this risk and
impact is known."

He said this can be done in several ways, including:

• Empowering the patient. "Patients should think about PAD if they have pain in
their legs and should mention PAD to the doctor." Hirsch said it was
important to try to reach women in this regard, as they also manage the
healthcare needs of their families.
• Better educate the doctor about PAD. "All clinicians need to think beyond
muscles and joints when dealing with any form of leg discomfort."
• Educate doctors about the ankle brachial index (ABI) test. "It is not difficult to
perform an ABI, but doctors don't do this test enough."

Women often have atypical symptoms

In the same way that women often have atypical symptoms of heart attack, they
also often have atypical symptoms of PAD, Hirsch explained. "Women with any
leg symptoms on exertion should be alert to the fact that it could be PAD. Classic
symptoms include cramping pains and overt discomfort in the muscles on
exercise. Atypical symptoms include any discomfort in the legs or in the heel that
is present at rest or during exercise or may not be confined to the muscle."

He noted that in contrast to the progress made in coronary heart disease in

recent years, with MI fatality rates coming down dramatically, PAD has not
enjoyed the same success. "It is not decreasing in prevalence, amputations are
continuing at the same rate, and costs are increasing.

"PAD is the poor relation of heart disease. Thirty years after we have known
about the risks, we are still not controlling this disease adequately. There is a
persistent focus on the pectoral region in cardiovascular disease," Hirsch
commented.
He added: "In North America, there are at least eight to 12 million people with
PAD, but most don't know they have it. In the Medicare population (adults over
65) 15% to 25% have PAD, but only 2% have ever had an ABI. This needs to
change."

Points made in the AHA scientific statement include the following:

• Although the age-dependent prevalence of PAD in adult women is lower than

for men, the total population burden of PAD appears to be higher.
• There appears to be a trend toward higher event rates for women than for men
with an ABI <0.90.
• Women (and particularly black females) are more likely than men to experience
graft failure or limb loss. There is therefore a need to identify women with
or at risk for PAD, especially black women, to lower cardiovascular
ischemic event rates, loss of independent functional capacity, and
ischemic amputation rates.
In a US survey, 75% of adults had no awareness of PAD as a disease, and those
at highest risk for PAD (the elderly and minorities) were the least informed.

Becker G. Physician Awareness: Results of a National Survey. Presented at the American

College of
Cardiology, updated March 2002.
2. Stein R. The Washington Post, Heart Disease Differs in Women, August 8, 2004.
3. Tuite C, Solomon JA, Krol K. Legs for Life® Data: Gender Differences and Trends, SIR
Annual Scientific Meeting, February 2004.