Top Things to Know: Sex Differences in Peripheral Vascular Disease
Published: March 11, 2025
Prepared by Ashley Wagner, PA-C, Associate Science and Medicine Advisor
- Data on sex-differences in peripheral vascular disease (PVD) is ill-defined, and there is a need to report and understand those sex-related differences in order to mitigate adverse outcomes related to those disparities.
- The purpose of this scientific statement is to report the current status of sex-based disparities in peripheral vascular disease and provide research priorities to achieve health equity for women with PVD.
- There are significant sex-based differences and disparities in epidemiology, risk factors, diagnosis, treatment, and outcomes of PVD, which are summarized in this scientific statement.
- While PVD encompasses vascular disease of the arteries, veins, and lymphatics, this scientific statement focuses solely on peripheral arterial disease (PAD), including aortic disease.
- Sex-based differences exist from pre-diagnosis screening through post-intervention outcomes within the spectrum of aortopathies. Notably, women experience a delayed presentation and higher mortality from acute aortic syndromes, worse outcomes after aortic repair, and a higher likelihood of being offered medical treatment for type A aortic dissection.
- There are significant differences in male and female predominance in different arteriopathies. Women are disproportionately represented in some arteriopathies such as fibromuscular dysplasia, vascular Ehlers-Danlos syndrome, splenic aneurysm, and chronic mesenteric ischemia.
- Among individuals with PAD, women are more likely to participate in supervised exercise therapy when referred, but they are less likely to receive a referral and less likely to be prescribed guideline-directed medical therapy.
- Women are underrepresented in randomized controlled trials of PVD, which can limit the available evidence to support clinical considerations or may offer limited applicability to the female population.
- Both sex and gender affect human health and disease, and it is suggested that both sex and gender be defined and included in cardiovascular disease research and reporting.
- Numerous disparities provide opportunities to pursue health equity for women with PVD. In future research, it is essential to ensure meaningful representation of diverse cohorts of women and to incorporate sex-based variables into both the design and reporting processes.
Citation
Kim ESH, Arya S, Bryce Y, Gornik HL, Long CA, McDermott MM, Pollak AW, Rowe VL, Sullivan AE, Whipple MO; 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 Medi¬cine; Council on Quality of Care and Outcomes Research; and Stroke Council. Sex differences in peripheral vascular disease: a scientific statement from the American Heart Association. Circulation. Published online March 11, 2025. doi: 10.1161/CIR.0000000000001310