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Canadian Journal of Cardiology

Women and Peripheral Arterial Disease: A Review of Sex Differences in Epidemiology, Clinical Manifestations, and Outcomes

Published:January 17, 2018DOI:https://doi.org/10.1016/j.cjca.2018.01.009

      Abstract

      Cardiovascular disease (CVD) is a leading cause of morbidity and mortality in women. Peripheral arterial disease (PAD), a manifestation of CVD and a marker for other adverse CVD outcomes such as ischemic heart disease and stroke, remains underrecognized and undertreated in women. Contrary to the previous belief that PAD is mainly a disease of white men, contemporary data suggest equal, if not higher, prevalence rates in nonwhite women. Women often present with asymptomatic or atypical disease and seek medical attention with more advanced disease. Cardiovascular morbidity and mortality rates, as well as procedural mortality rates, remain elevated in women compared with men. There are sex-specific markers and comorbidities with a higher female prevalence that are associated with PAD. Greater focus on PAD in cardiovascular trials, equivalent enrollment of women in large trials, and focused prevention strategies may help reduce the economic burden and adverse outcomes associated with PAD in women.

      Résumé

      La maladie cardiovasculaire (MCV) est une des principales causes de morbidité et de mortalité chez les femmes. L’artériopathie périphérique (AP), manifestation de la MCV et marqueur d’autres formes de MCV, comme la cardiopathie ischémique et l’accident vasculaire cérébral, demeure insuffisamment reconnue et sous-traitée chez les femmes. Contrairement aux vieilles idées reçues voulant que l’AP soit essentiellement une maladie touchant les hommes blancs, les données contemporaines suggèrent que sa prévalence est égale, voire supérieure, chez les femmes non blanches. Les femmes présentent souvent une maladie asymptomatique ou atypique et consultent un médecin lorsque la maladie est à un stade avancé. Les taux de morbidité et de mortalité cardiovasculaires ainsi que les taux de mortalité périopératoires restent élevés chez les femmes comparativement aux hommes. Des marqueurs selon le sexe ainsi que des facteurs de comorbidité ayant une plus grande prévalence chez les femmes sont associés à l’AP. Une prise en compte accrue de l’AP dans le cadre des essais consacrés à la maladie cardiovasculaire, l’inscription d’un nombre équivalent d’hommes et de femmes aux essais d’envergure et le recours à des stratégies de prévention ciblées pourraient contribuer à réduire le fardeau économique et les résultats défavorables associés à l’AP chez les femmes.
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