About 8 million people in the United States have peripheral artery disease (PAD), a condition that, if left untreated, increases heart attack and stroke risks, severely limits walking ability, and causes tissue death requiring limb amputation. The prevalence of PAD is nearly equal between men and women (Figure). Only about 10% of individuals with PAD experience classic, recognized exertional claudication, and many people experience no symptoms at all. As a result, few individuals with PAD receive prompt diagnosis or treatment. “The mortality rate and healthcare costs associated with PAD are comparable to those of heart disease and stroke,” says Alan T. Hirsch, MD. “Women, in particular, suffer an immense burden from PAD, but current data suggest that most women remain unaware of their risk. PAD continues to go largely unrecognized and untreated in women.”
An Important Scientific Statement on PAD
In the March 20, 2012 issue of Circulation, the American Heart Association (AHA), in collaboration with the Vascular Disease Foundation and the P.A.D. Coalition, released a scientific statement on women and PAD. It recommends that healthcare providers proactively increase awareness of and test women at risk for PAD. It also calls for more women-focused research into the disease.
“There is a great need to identify women with PAD and those who are at risk for it, especially African-American women, so that we can help lower cardiovascular ischemic event rates,” says Dr. Hirsch, who was the chair of AHA writing group that developed the call-to-action statement. “This may also reduce the loss of independent functional capacity and ischemic amputation rates.” He notes that women in the United States already attend as many or more PAD physician visits as men, confirming the large burden of the disease in women.
PAD Awareness Continues to Lag
Awareness of PAD in women and men is strikingly low when compared with knowledge of other cardiovascular diseases (CVDs) and other conditions. According to current data, women may be somewhat more aware of PAD and its risk than their male counterparts. That said, improving or eliminating knowledge gaps would provide a major opportunity to enhance the health of women significantly. Greater efforts are needed to increase awareness of the major risk factors of PAD—including age over 50, smoking, and diabetes— as well as other risk factors associated with the disease, including hypertension, high cholesterol, and a family history of PAD.
“Research on PAD in women has lagged far behind that of men,” Dr. Hirsch says. “As healthcare providers, we must include more women as a key target audience when we develop studies on PAD prevention, diagnosis, and treatment. Currently, there has been an amazingly low rate of inclusion of women in clinical trials to provide a clear understanding of how the disease progresses or to determine its true incidence and prevalence in women. More research studies of PAD specifically among women will hopefully help us obtain an adequate, representative sample size of females to draw sound conclusions.”
Making Peripheral Arterial Disease a Priority
PAD is addressed in government-sponsored education programs and activities, but it is not currently positioned as its own distinct topic in women’s cardiovascular health programs. “It’s important to increase cross-communication between women’s heart health programs and PAD awareness campaigns,” adds Dr. Hirsch. “This could create more unified and compelling risk reduction messages. It may also help identify women with symptomatic disease earlier so that treatments can be initiated. It’s important to provide information on PAD that recognizes it as a distinct disease rather than simply a ‘risk factor’ for other CVDs.”
Funding new research to help determine how gender may affect the rate of development of PAD, responses to medications, and the potential benefits of vessel-opening procedures is another recommendation that is stressed in the AHA scientific statement (Table). Several heart health promotion campaigns have emerged in recent years, including those from the P.A.D. Coalition and the AHA’s Go Red For Women campaign.
“These efforts have been beneficial in that they provide specific education regarding PAD,” says Dr. Hirsch. “The hope is that these campaigns will encourage women to learn about their unique risks and talk openly and honestly with their healthcare providers about PAD. At that teachable moment, physicians can make an impact by educating their patients about the prevention and treatment options that can help them save their lives and limbs. For most adult women, a PAD assessment would be at least as important as a breast examination or PAP smear. This PAD risk is greater than that of gynecologic malignancy. Making a clear and strong message about PAD to women will help improve PAD-related health as well as global cardiovascular health.”
Hirsch AT, Allison MA, Gomes AS, et al. A call to action: women and peripheral artery disease: a scientific statement from the American Heart Association. Circulation 2012 Feb 15 [Epub ahead of print]. Available at: http://circ.ahajournals.org/content/early/2012/02/15/CIR.0b013e31824c39ba.full.pdf+html.
Hirsch AT, Murphy TP, Lovell MB, et al; Peripheral Arterial Disease Coalition. Gaps in public knowledge of peripheral arterial disease: the first national PAD public awareness survey. Circulation. 2007;116:2086-2094.
Rooke TW, Hirsch AT, Misra S, et al. 2011 ACCF/AHA focused update of the guideline for the management of patients with peripheral artery disease (updating the 2005 guideline): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2011;124:2020-2045.
Higgins JP, Higgins JA. Epidemiology of peripheral arterial disease in women. J Epidemiol. 2003;13:1-14.
Mosca L, Benjamin EJ, Berra K, et al. Effectiveness-based guidelines for the prevention of cardiovascular disease in women—2011 update: a guideline from the American Heart Association. Circulation. 2011;123:1243-1262.
Bush RL, Kallen MA, Liles DR, et al. Knowledge and awareness of peripheral vascular disease are poor among women at risk for cardiovascular disease. J Surg Res. 2008;145:313-319.